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Objective: To examine the incidence of percutaneous spinal cord stimulator lead migration, given current hardware and surgical technique., Materials and Methods: We retrospectively reviewed records of patients who underwent spinal cord stimulator implantation with percutaneous leads at our institution from 2008 through 2011. We determined the number of patients who required surgical revision for clinically significant lead migration., Results: Clinically significant lead migration requiring surgical revision occurred in three of 143 patients (2.1%) with primary SCS system implants utilizing percutaneous-type leads., Conclusions: The rate of lead migration observed in our practice was considerably lower than previously published estimates of clinically significant lead migration or revision for lead migration (13%-22%). However, our study did not determine the reason for the decreased rate, which may be influenced by current hardware and implant techniques., (© 2014 International Neuromodulation Society.)

Introduction: Spinal cord stimulation (SCS) is the most commonly used implantable neurostimulation modality for management of pain syndromes. We present a patient with history of right facial pain successfully treated for refractory angina with SCS and had coincident near resolution of facial pain., Case Description: A 45 year old male with documented coronary vasospasm presented for consideration of SCS for refractory angina. He underwent successful implantation with significant improvement in his intractable chest pain. Additionally, during trial and post-implantation, the patient described almost complete resolution of his chronic facial pain. Prior to implantation, the facial pain had been thoroughly evaluated without a discernible cause. He had been symptomatically treated for atypical facial pain (AFP) with gabapentin. Post-implantation, the patient was able to discontinue gabapentin and described near complete resolution of his AFP., Discussion: SCS is one of the most promising treatment options for refractory angina. Numerous randomized, controlled trials have demonstrated efficacy in increasing exercise duration and time to angina, decreasing number of angina attacks, sublingual nitrate consumption, and number of ischemic episodes. Reductions in pain, sympathetic tone, and myocardial oxygen demand as well as improvement in coronary microcirculatory blood flow have all been proposed as beneficial outcomes of stimulation. AFP is a poorly understood condition, often without etiology, and most commonly treated symptomatically. The resolution of our patient's AFP is secondary to unclear mechanism(s). We propose SCS may have altered central processing or spinal trigeminal nucleus fibers; additionally, the pain may have been sympathetically mediated and altered by SCS.

Accidental puncture of the dura mater with resultant leakage of cerebral spinal fluid (CSF) and development of postdural puncture headache (PDPH) is a known potential complication of percutaneous placement of spinal cord stimulator (SCS) leads. However, the implications and management strategies for this complication have not been thoroughly reported. We report two cases of SCS lead placement complicated by CSF leak and PDPH.

Introduction: Radiofrequency ablation (RFA) and spinal cord stimulation (SCS) are 2 common modalities used in management of various pain conditions. RFA generates heat and an electromagnetic field that can theoretically interfere with the functionality and longevity of the SCS device. This is problematic for patients who need RFA and have previously undergone implantation of an SCS device. Case Description: We present a case highlighting the safe use of bipolar RFA in a patient who had previously undergone implantation of a cervical SCS device. Discussion: We also present device‐specific industry guidelines and recommendations for performing RFA in patients following SCS device implantation. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The goal of this study was to determine the frequency and clinical indications associated with implantation of single vs. dual percutaneous lead spinal cord stimulator (SCS) systems and to look further into how these leads are utilized for treatment. Materials and Methods: A retrospective cohort analysis of all patients undergoing SCS implantation between January 2001 and December 2013 with a minimum of 2 years of clinical follow‐up was performed. Number of trial leads and implanted leads was recorded. For patients with dual‐lead systems, it was noted if and when the second lead was used, along with the clinical indication for lead activation. Results: In the 259‐patient cohort, 15.8% (n = 41) patients underwent placement of a single‐lead system, 83.0% (n = 215) underwent placement of a dual‐lead system, and 1.2% (n = 3) underwent placement of 3‐lead systems. Placement of dual‐lead systems was similar among all indication groups. Of those patients with a dual‐lead system in place, 88.1% utilized both leads and average time to programming of the second lead was 2.3 months. The most common reason to activate the second lead was inadequate stimulation coverage. Five of the 41 patients with single‐lead systems underwent an additional surgery to implant a second lead due to inadequate stimulation with 1 lead. Conclusions: To our knowledge this is the first descriptive analysis of the frequency of single‐ and dual‐lead SCS systems. This report indicates that dual‐lead systems are most often placed and both leads are required for optimal patient therapy. [ABSTRACT FROM AUTHOR]