Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
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BACKGROUND: Common long-term complications for neuromodulation include lead migration, loss of efficacy of therapy, and lead malfunction. The following case describes pitfalls of lead migration and preventative steps to decrease risk of this complication.
CASE REPORT: This is an independent case study following the outcome of one patient diagnosed with complex regional pain syndrome that had failed conservative therapy. She underwent implantation of a spinal cord stimulator (SCS) with > 90% relief. Loss of relief was described on follow-up. On reimaging, the SCS had migrated cephalad and this was likely the cause of the malfunction.
CONCLUSIONS: Lead migration can occur at any time, even years after initial implantation. Recommendations from the literature and gained from this case include heightened vigilance and suspicion when a patient encounters sudden failure of pain relief, low threshold for new imaging to assess lead location, and use of mechanical anchoring devices.
KEY WORDS: Neuromodulation, spinal cord stimulator, CRPS, chronic regional pain syndrome, pain, chronic pain, case report
