Disclosures: Edward J. Chang:

Objective: A common issue related to Spinal Cord Stimulator (SCS) trialing is migration of leads from their therapeutic location. Our goal is to investigate the extent of lead migration in patients during a 7-day trial period, with regards to distance and directionality.

Design: Cross-sectional, observational studySetting : An outpatient orthopedic surgery center and pain clinicParticipants : 35 patients who previously underwent SCS trialing from 2015-2020. These patients were diagnosed with cervical or lumbar radiculopathy, complex regional pain syndrome, and post laminectomy pain syndrome.

Interventions: After failing conservative therapies for their respective diagnosis, all patients underwent SCS trialing. Their stimulators were monitored and adjusted for a period of 7 days before undergoing permanent implantations.

Main Outcome Measures: Images from the patients’ fluoroscopic SCS trial implantation and postoperative x-rays were identified and selected for analysis. The left and right leads were located relative to the superior end plate of the target vertebral body, then calculated as a percentage of the vertebral body’s height. This was compared to postoperative imaging during the trialing period. We measured the initial and final lead locations and calculated a migration distance in millimeters based on our measurements of the vertebral body.

Results: Initial lead placement in 77% of the patients were between T7-T9. Of the 35 patients assessed, 30 patients had lead migrations greater than 5mm on both sides during the 7-day period. Average total lead migration was 19.11mm inferiorly (standard deviation of 21.7mm), which correlated to 94.44% of vertebral body height (standard deviation of 105.88).Conclusions: Quantifying lead migrations that occur during trialing will allow clinicians to account for movement and understand how to optimize the desired therapeutic effect of SCS. Future studies that focus on larger populations may help in establishing best practice guidelines for SCS trialing, thus improving overall efficacy.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/measuring-spinal-cord-stimulator-lead-migrations-during-trialing/