A direct tying loop of silk sutures on the electrode

Corresponding author: Ji Hee Hong, M.D., Ph.D., Department of Anesthesia and Pain Medicine, Keimyung University School of Medicine, 56, Dalseong-ro, Jung-gu, Daegu 700-712, Korea. Tel: 82-53-250-7288, Fax: 82-53-250-7240, E-mail: [email protected] This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. CC Editor, we experienced a case of lead migration in spinal cord stimulation (SCS), which was successfully corrected and fixed by tying the loops of silk sutures directly around the lead. A-42-year-old man visited our pain clinic with a complaint of burning pain, causalgia, and paresthesia in both legs. Despite continuous conservative therapy, severe pain persisted in the lower back, both buttocks, and knee and ankle areas; therefore, we decided to try spinal cord stimulation. After confirmation of induced paresthesia at the painful site, the lead and extension cables were connected, and a cylindrically shaped hard plastic was used for anchoring. Suture tying on the middle part of the cylindrically shaped hard plastic was performed with black silk. On the second day during the lead trial, paresthesia of the left leg disappeared; however, paresthesia developed in the lower abdomen. Although we changed the programming, paresthesia never developed at the painful site again. We suspected migration of the lead and checked the position of the lead through a T-L spine X-ray. On the left side, migration of the lead occurred in the cephalad direction, and the lead was positioned at the middle of the T7 level. To correct the position of the lead, we pulled the lead to the middle of the ninth vertebral body. Anchoring was performed again, and suture tying on the middle part of the cylindrically shaped hard plastic was performed with black silk. In addition, we made direct tying loops of silk sutures around the lead at the proximal site of the anchoring to prevent lead migration in the longitudinal direction again (Fig. 1). After revision of the lead, the patient could feel the paresthesia again on the painful side and the lead’s position was maintained without any migration. Lead migration results in a loss of proper paresthesia coverage and a subsequent reduction in pain relief. Andersen [1], reporting on the use of SCS for angina, found that the most frequent complication requiring repeated surgery was lead migration (23%). Introduction of multichannel leads has greatly reduced the need for repeated revision as the result of lead migration. North et al. [2] found that programmable multichannel systems have a significantly greater clinical reliability than single-channel systems. Our patient also used multipolar leads; however, despite repeated trials of reprogramming, we failed in re-generation of paresthesia. When we checked the position of the lead, the lead had moved almost two vertebral levels, which is too far for generation of paresthesia to the painful site.