Revision of an Eight-lead Boston Scientific® Spinal Cord Stimulator With Epidural Migration: A Case Report

Abstract

Spinal cord stimulation (SCS) is a minimally invasive neuromodulation technique utilized to manage chronic pain conditions such as complex regional pain syndrome (CRPS), post-laminectomy syndrome, and peripheral neuropathy. Despite its efficacy, complications, including lead migration, discomfort, and device malfunction, can occur. We present the case of a male patient in his 60s with a history of chronic left lower extremity pain who underwent SCS implantation. Initial management included a successful trial period followed by permanent implantation. However, postoperative imaging revealed lead migration from the T10-T12 to the T12-L1 vertebral bodies. A subsequent lead revision was performed, yet the patient later experienced new abdominal pain due to further lead migration, necessitating referral to neurosurgery for paddle lead placement. The revision procedure involved reopening the initial incision, carefully removing scar tissue, and repositioning the lead within the epidural space using fluoroscopic guidance. The lead was anchored with a self-anchoring mechanism, and the incision was closed meticulously. Post revision, the patient experienced significant pain relief, confirmed by stable lead positioning on imaging. Unfortunately, lead migration recurred months later, leading to the decision for paddle-lead implantation. This case highlights the complexities of SCS implantation, particularly lead migration, and the importance of meticulous surgical technique and preoperative planning. The challenges of scar tissue formation and lead maneuverability are discussed, with a focus on improving fixation mechanisms and exploring alternative lead designs. Lead migration is a significant complication in SCS implantation that can compromise pain management efficacy. Vigilant postoperative monitoring, prompt revision, and advancements in lead design and fixation are essential to optimizing patient outcomes and minimizing the need for further interventions