Spinal Cord Stimulator—Trial Lead Migration Study

Abstract

Percutaneous SCS trial electrodes migrate significantly, inferiorly, during a 3-day trial. Anchoring the trial electrodes to the skin with a suture and tape results in significantly greater inferior migration when compared with anchoring the lead with tape only.

Cephalad Lead Migration During a Spinal Cord Stimulation Trial: A Case Presentation

“…The leads in this case were anchored with Steri-Strips. Suturing would have likely prevented the significant migration seen in this case; however, based on the data from Osborne et al, it is difficult to argue that suturing is better than tape [6]. The orientation of the tape may have contributed as well.…”

“…The orientation of the tape may have contributed as well. In this case multiple Steri‐Strips were placed horizontally across the leads near the skin entry site and distal to it, whereas Osborne et al describe 3 strips oriented in a “fan type configuration” with 3 additional Steri‐Strips placed horizontally across the first 3 strips [6]. The outermost Medipore bandage in this case also came loose and likely loosened the skin closure tape, contributing to the lead migration.…”

“…We apply skin closure tape in a “fan” or “tepee” orientation around the leads as they exit the skin, followed by a retention loop and horizontal tape just distally. This is somewhat similar to the method described by Osborne et al We also use a liquid adhesive (Mastisol, Eloquest Healthcare, Ferndale, MI) to keep the tape secure [6]. We make sure that the outer adhesive bandage is secure, and instruct patient on the importance of keeping the leads covered and limiting manipulation of the tape or leads.…”

“…There is currently no consensus on a method for anchoring percutaneous leads, although the application of silicone elastomer adhesive has been reported to minimize migration [4]. In comparing anchoring methods, Osborne et al found that leads anchored with tape and suture migrated caudally more than leads anchored with tape only [6]. Leads anchored with tape migrated an average of 8.72 mm (SD ¼ 5.77), whereas leads anchored with suture and tape migrated 24.49 mm (SD ¼ 11.3).…”

“…Although there have been reports of caudal lead migration, there have been no reports of significant cephalad lead migration during SCS trials. Osborne et al investigated migration of percutaneous spinal cord stimulator leads with 20 patients during a 3‐day trial and found that leads migrate caudally [6]. Leads anchored with tape migrated inferiorly an average of 8.72 mm (standard deviation [SD] = 5.77), and only 1 lead out of 20 migrated cephalad by 0.3 mm.…”