• Sami Ridwan, Burkhard Ostertun, Henning Stubbe, and Franz-Josef Hans.
• Department of Neurosurgery, Intensive Care and Pain Management, Paracelsus-Klinik Osnabrueck, Osnabrueck, Germany. Electronic address: sami.ridwan@yahoo.de.
• World Neurosurg. 2020 Sep 1; 141: 247-250.

BackgroundSpinal cord stimulation for failed back surgery syndrome and chronic pain is a well-established treatment regimen today. Lead migration is the most common complication; mainly epidural caudal more than cranial electrode migration from the primary position is described repeatedly throughout the literature.Case DescriptionA 60-year-old male patient with failed back surgery syndrome was eligible for spinal cord stimulation. Surgery had been performed 4 weeks before readmission with proper lead positioning of both electrodes in the midline of the epidural space. The electrode fixation mechanism at L2/3 had to be revised and was replaced with multiple ligature fixations due to the patient's slim build. He presented to our outpatient clinic with thoracic right-sided pain matching T5 with signs of overstimulation of the paravertebral muscles. X-ray imaging revealed cranial migration of 1 lead to T4 and a right-sided extraspinal migration of the other lead along a spinal nerve in T5 exiting the neuroforamen and following beneath the corresponding rib dorsally. Revision surgery was performed using a thoracic paddle electrode.ConclusionsLead migration remains a challenge in spinal cord stimulation regardless of the fixation method. Rare unusual migration patterns in addition to simple caudal or cranial migration might pose a challenge for revision surgery and thus might reduce overall treatment efficacy.Copyright © 2020 Elsevier Inc. All rights reserved.

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