Lead Migration Research Articles

A paramedian approach for dorsal root ganglion stimulation placement developed to limit lead migration and fracture.

Dorsal root ganglion stimulation (DRG-S), has demonstrated superiority in the treatment of complex regional pain syndrome and causalgia. Lead migration and fracture impact DRG-S therapeutic stability. Lead anchoring reduces DRG-S lead migration without increasing lead fracture. Lead fracture may be related to lead entrapment in the superficial fascial plane. A novel medialized approach for lead placement and anchoring is presented to address these issues. We suggest an alternative technique for implanting percutaneous DRG-S leads at the T10-L5 levels. A novel medialized ipsilateral technique for lead placement and anchoring for single, bilateral, and adjacent segment placement is presented. The Tuohy needle puncture site is medial to the pedicle and adjacent to the spinous process, two vertebral levels caudad to the target foramen. Trajectory is maintained in the sagittal plane, to access the caudad interlaminar space near the midline. This technique allows for ipsilateral or contralateral lead placement. After epidural access, the introducer sheath is rotated toward the targeted foramen and advanced. The guidewire followed by the lead is passed, and once lead position is confirmed, tension "S" loops are created, followed by anchoring to the deep fascia. We describe a new paramedian technique for DRG-S lead placement. We propose it will decrease DRG-S complication rates through anchoring to reduce migration and by avoiding the fascial planes thought to be responsible for fracture. Long-term outcomes applying our proposed techniques are required for determining the true impact, however, early anecdotal results suggest that these new techniques are favorable.

Migration of lead and cadmium from ceramic kitchenware and estimation of sampling uncertainty

The aims of this study were (i) to evaluate the existing analysis capacity for lead and cadmium leached from ceramic articles, (ii) to determine the migration of lead and cadmium from glazed ceramic kitchenware sold on the Turkish market, (iii) to estimate the sampling uncertainty. Traditional ceramic cooking ware and Chinese breakfast hollowware were sampled randomly from different sales points located in Bursa in 2018 (n = 96). Ceramic articles were subjected to the migration conditions specified in the legislation, and the amount of lead and cadmium was determined with the inductively coupled plasma and mass spectrometry. It was found that the current analytical method can quantify lower levels of the metals with acceptable method performance parameters. The amount of the metals migrated were far below the current permissible limits set in the legislation. Relative sampling uncertainty was estimated as 66.1% and this result was related to the heterogeneity within a lot. Practical applications Lead and cadmium are used to coat the ceramic kitchenwares during the glazing process. If ceramic kitchenware are produced under good manufacturing conditions and the glaze is undamaged, the migration of lead and cadmium may be lower than the permissible limits set in the legislation. Migration analysis based on inductively coupled plasma mass spectrometry (ICP-MS) provides high selectivity, sensitivity, and low analytical limits. Considering inevitable sampling uncertainty, at least four articles should be taken from a lot for migration analysis.

Wireless Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Trigeminal Pain: A Single Center Experience

Subcutaneous trigeminal nerve field stimulation (sTNFS) is a neuromodulatory treatment for neuropathic trigeminal pain with the ability to reduce the intensity and frequency of pain attacks. However, hardware issues including lead migration, skin erosion, infection, so-called pocket pain at the site of the implanted neurostimulator are reported. Implantable wireless neurostimulation technology promises not only an even less invasive sTNFS treatment and thinner and more flexible electrodes better suited for facial implants, but also provides further advantages such as lack of an implantable neurostimulator and 3T magnetic resonance imaging compatibility. All patients who had received trial stimulation with a partially implantable sTNFS system were analyzed for ICHD-3 (3rd edition of the International Classification of Headache Disorders) diagnosis, success of trial stimulation, pre- and postoperative pain intensity, frequency of attacks, complications, and side-effects of sTNFS. All patients (N=3) responded to sTNFS (≥50% pain reduction) during the trial period. According to ICHD-3, N=2 of the patients were classified with trigeminal neuralgia (TN) with concomitant persistent facial pain and N=1 patient with multiple sclerosis associated TN. The time of the test period was 44 ± 31.24 days (mean ± SD). The average daily duration of stimulation per patient amounted 2.5 ± 2.2hours (range 1-5). The pain intensity (defined on a visual analog scale) was reduced by 80% ± 17% (mean ± SD). Reduction or cessation in pain medication was observed in all patients. No surgical complications occurred in the long-term follow-up period of 18.84 ± 6 (mean ± SD)months. The partially implantable sTNFS device seems to be safe, effective, and reliable. Compared to conventional devices, the equipment is not limited to the length of trial stimulation. Furthermore, the daily stimulation duration was much shorter compared to previous reports.

Vimentin-Rab7a Pathway Mediates the Migration of MSCs and Lead to Therapeutic Effects on ARDS.

Acute respiratory distress syndrome (ARDS) is difficult to treat and has a high mortality rate. Mesenchymal stem cells (MSCs) have an important therapeutic effect in ARDS. While the mechanism of MSC migration to the lungs remains unclear, the role of MSCs is of great clinical significance. To this end, we constructed vimentin knockout mice, extracted bone MSCs from the mice, and used them for the treatment of LPS-induced ARDS. H&E staining and Masson staining of mouse lung tissue allowed us to assess the degree of damage and fibrosis of mouse lung tissue. By measuring serum TNF-α, TGF-β, and INF-γ, we were able to monitor the release of inflammatory factors. Finally, through immunoprecipitation and gene knockout experiments, we identified upstream molecules that regulate vimentin and elucidated the mechanism that mediates MSC migration. As a result, we found that MSCs from wild-type mice can significantly alleviate ARDS and reduce lung inflammation, while vimentin gene knockout reduced the therapeutic effect of MSCs in ARDS. Cytological experiments showed that vimentin gene knockout can significantly inhibit the migration of MSCs and showed that it changes the proliferation and differentiation status of MSCs. Further experiments found that vimentin's regulation of MSC migration is mainly mediated by Rab7a. Rab7a knockout blocked the migration of MSCs and weakened the therapeutic effect of MSCs in ARDS. In conclusion, we have shown that the Vimentin-Rab7a pathway mediates migration of MSCs and leads to therapeutic effects in ARDS.

THE EFFECT OF TEMPERATURE AND TIME ON THE MIGRATION OF LEAD METAL (PB) IONS IN CANNED ORANGE JUICE DRINK USING ATOMIC ABSORPTION SPECTROPHOTOMETRY ANALYSIS

Background: Indonesia is a country that has a tropical climate throughout the year along with relatively less difference of temperature during both dry and rainy seasons. The mobile community influences people’s interest in packaged drinks, including canned fruit juice. However, the first obstacle is the condition of the place and the temperature-related heavy metal lead (Pb) migration in canned orange juice drinks. Methods: This study focused on the relationship between Pb metal content, storage treatment, storage temperature, and storage time. This study used a canned orange juice drink from the distributor warehouse of Palembang city, standard Pb(NO3)2 (Merck) powder, 0.5 mol/l concentrated HNO3 solutions (Merck), concentrated HCl solution (Merck), demineralized water, Buffer pH 4.7, and 10. The sample was conducted from 5 °C to 40 °C with the testing period within 1-30 days. The sample at certain day intervals would then be tested to change pH and Pb ion concentration using the Atomic Absorption Spectrophotometry (AAS) test. Results and Discussion: In this study, the sample of orange juice was given different treatments, and each treatment has a differentiated analysis code consisting of S-SBJ-1-1 (Distributor warehouse) for one day of storage time, and the codes for 10 of storage time are SSBJ-10-1 (Freezer, temperature 5 °C), S-SJB-10-2 (Refrigerator, temperature 20 °C), S-SJB-10-3 (Homeroom, temperature 28 °C), S-SJB-10-4 (Oven, temperature 40 °C), S-SJB-10-5 (Open space, temperature 22°C - 38 °C). Furthermore, codes for 30 days of sample storage are S-SBJ-30-1 (Freezer, temperature 5 °C), S-SJB-30-2 (Refrigerator, temperature 20 °C), S-SJB-30-3 (Room house, temperature 28 °C, S-SJB-30-4 (Oven, temperature 40°C), and S-SJB-30-5 (Open space, temperature 22 °C-38 °C). Conclusions: Temperature and time have a significant influence on the migration of the heavy metal lead (Pb) from the can to orange juice drinks, and, for the minimum pH value, there is a less significant change. Overall, canned fruit juice should be stored at a temperature below 28 °C, and the drink is protected from direct sunlight and high humidity.

Lead migration and fracture rate in dorsal root ganglion stimulation using anchoring and non-anchoring techniques: A multicenter pooled data analysis.

Dorsal root ganglion stimulation (DRG-S) is a neuromodulation technique introduced in the last decade with evolving implant methods. Initial prospective research found low incidences of lead migration and lead fracture with DRG-S. However, several recent studies have highlighted high lead migration and lead fracture rates with DRG-S. We investigated the influence of lead anchoring on migrations and fractures. We performed a retrospective review between 2016 and 2020 of individuals implanted with DRG-S leads by 4 experienced implanters. The implanters independently changed their standard practice regarding lead anchoring over time, with opposing trends (no anchoring>anchoring, anchoring>no anchoring). We compared lead migration and lead fracture rates between anchored and unanchored DRG-S leads in the entire study cohort. Cox regression was performed on lead migration and fracture distributions. We included 756 leads (n=565 anchored and n=191 unanchored) from 249 patients. In unanchored leads, migration occurred in 16 leads (8.4%) from 13 patients (21.0%). In anchored leads, migration occurred in 8 leads (1.4%) from 5 patients (2.7%). Fracture in unanchored leads occurred in 6leads (3.1%) from 6 patients (9.7%). Fractures in anchored leads occurred in 11 leads (1.9%) from 9 patients (4.8%). The migration survival distributions for the anchored and unanchored leads were statistically significantly different (p<0.01) with decreased survival for unanchored leads (hazard ratio = 5.8, 95% confidence interval [CI] = 2.2-15.5). We found that anchoring DRG-S leads significantly reduces lead migration when compared to leads placed without an anchor. There was no significant difference in fracture rate between anchored and unanchored leads.

Determination of Level of Lead (Pb) and Cadmium (Cd) Migration on Bowl and Clear Plastic Cup Using Atomic Absorption Spectrophotometer

Food safety is a condition and efforts needed to prevent food from biological and chemical pollutants and other things that might irritate, harm, endanger human health. So the food is safe to consume. Besides, it should not against religion, faith, and culture. Chemical pollutants may come from migration of the food container or packaging, for example from a bowl or clear plastic cup. Migration happens as a result of the high temperature of food, duration of storage, and the production process. The higher the temperature the higher the possibility of migration. The existence of lead (Pb) and cadmium (Cd) in food may be because of environmental pollution, absorption of metal from equipment. Research has been conducted on the determination of the level of lead (Pb) and cadmium (Cd) from the migration of some bowls and plastic glasses that are available online by using spectrophotometer atomic absorption. The research is using acetic acid 4 % simulant. The sample is identified by using Near Infra-Red. The result of two kinds of plastic bowls and one kind of clear plastic cup are Polypropylene (PP). The sample is filled with acetic acid 4% simulant, stored in a dark place for twenty- four hours, then it is measured with Atomic Absorption Spectrophotometer (AAS). In all samples consist of two kinds of bowls and one clear plastic cup. The lead and cadmium are not detected with a limit of detection (LoD) Pb is 1.33 µg/ml dan (LoD ) Cd is 0.22 µg/ml, while the limit of quantitative (LoQ) Pb is 4.43 µg/ml and ( LoQ) Cd is 0.74 µg/ml. LoD dan LoQ for lead is too high because are using AAS Flame, while ideally using AAS Graphite Furnace.

Initial experience using a novel nerve stimulator for the management of pudendal neuralgia.

In patients with pudendal neuralgia, prior studies have shown efficacy in chronic stimulation with Interstim® (Medtronic, Inc.). This feasibility study reports on the initial experience of using a wireless system to power an implanted lead at the pudendal nerve, StimWave®, to treat pudendal neuralgia. Retrospective chart review identified patients with a lead placed at the pudendal nerve for neuralgia and powered wirelessly. Clinical outcomes were assessed at Postoperative visits and phone calls. Administered non-validated follow-up questionnaire evaluated the Global Response Assessment, percentage of pain improvement, satisfaction with device, and initial and current settings of the device (h/day of stimulation). Thirteen patients had the StimWave® lead placed at the pudendal nerve, 12 (92%) female and 1 (7.6%) male. Mean age was 50 years (range: 20-58). Failed prior therapies include medical therapy (100%), pelvic floor physical therapy (92%), pudendal nerve blocks (85%), pelvic floor muscle trigger point injections (69%), neuromodulation (30.7%), or surgeries for urogenital pain (23.1%). After the trial period, 10/13 (76.9%) had >50% improvement in pain with 6/13 (46.1%) reporting 100% pain improvement. Nine underwent permanent lead placement. At last postoperative visit (range, 6-83 days), 5/9 patients reported >50% pain improvement. Seven patients reached for phone calls (22-759 days) reported symptoms to be "markedly improved" (n = 2), "moderately improved" (n = 4), or "slightly improved" (n = 1). At follow up, complications included lead migration (n = 2), broken wire (n = 1), or nonfunctioning antenna (n = 2). Complex patients with pudendal neuralgia may benefit from pudendal nerve stimulation via StimWave®.

Lead Migration in Neuromodulation

We describe a simple technique of securing surgically implanted leads for spinal cord (SCS), dorsal root ganglion (DRG) and occipital nerve stimulation (ONS), for both primary surgical implantation and correcting lead migration. This technique could also be adapted for securing percutaneously implanted leads. Thirty-nine patients underwent neurosurgical implantation of SCS, DRG, and ONS devices utilizing titanium mini-plates to obtain secure anchorage of leads to adjacent laminae close to their exit point from the epidural space, thereby minimizing the risk of further lead migration or electrode displacement. There were no cases of primary or recurrent lead migration in any patient undergoing lead placement using mini-plate anchorage. The technique appears to offer a reliable means of preventing post-operative lead migration in a variety of spinal and extra-cranial neuromodulation implants.

Experience of Lead Pollution Control in Outdoor Shooting Ranges in the United States

In this paper, the exposure ways and risks of lead in the shooting field are discussed, the factors influencing lead migration in the soil are analyzed, and the control measures and the methods of removing and recovering lead in the soil are summarized. The results demonstrate that soil pH has a great influence on the mobility of lead, which can be reduced by applying lime to improve soil pH. However, this approach is only suitable for daily maintenance. The removal of lead completely depends on screening and soil leaching, which can remove more than 99% of the lead particles.

An unusual case of lead migration in occipital nerve stimulation: A case report and literature review

Background: Lead migration is a complication associated with occipital nerve stimulation (ONS). We present a rare case in which fibrosis in the stress relief loop caused lead migration in the treatment of occipital neuralgia.Case Description: A 30-year-old woman with a 5-year history of refractory occipital neuralgia, who had been under ONS therapy for 2 months, presented with a sudden onset of typical occipital neuralgia pain associated with cervical muscles spasms and myoclonus. A skull radiography showed lead migration. The patient underwent surgery for lead repositioning. During surgery, we identified extensive fibrosis throughout the stress relief loop that produced several constriction points. The fibrosis in the stress relief loop increased tension on the lead during head-and-neck movement, causing progressive migration of the lead.Conclusion: Although lead migration is a common complication of ONS, its association with fibrosis in the stress relief loop has not, to the best of our knowledge, been reported before. Lead migration can directly affect treatment outcome and it is, therefore, important to fully understand the possible mechanisms that can cause it and how to promptly manage them.

Simulation study of spinal cord stimulation evoked compound action potential

Spinal cord stimulation (SCS) for pain is usually implanted as an open loop system using unchanged parameters. To avoid the under and over stimulation caused by lead migration, evoked compound action potentials (ECAP) is used as feedback signal to change the stimulating parameters. This study established a simulation model of ECAP recording to investigate the relationship between ECAP component and dorsal column (DC) fiber recruitment. Finite element model of SCS and multi-compartment model of sensory fiber were coupled to calculate the single fiber action potential (SFAP) caused by single fiber in different spinal cord regions. The synthetized ECAP, superimposition of SFAP, could be considered as an index of DC fiber excitation degree, because the position of crests and amplitude of ECAP corresponds to different fiber diameters. When 10% or less DC fibers were excited, the crests corresponded to fibers with large diameters. When 20% or more DC fibers were excited, ECAP showed a slow conduction crest, which corresponded to fibers with small diameters. The amplitude of this slow conduction crest increased as the stimulating intensity increased while the amplitude of the fast conduction crest almost remained unchanged. Therefore, the simulated ECAP signal in this paper could be used to evaluate the degree of excitation of DC fibers. This SCS-ECAP model may provide theoretical basis for future clinical application of close loop SCS base on ECAP.

Multisystem Spinal Cord Stimulation Trialing: A Single Center, Retrospective, Observational Study

Spinal cord stimulation is a well-established modality for the treatment of chronic intractable pain. The safety and efficacy of various stimulation therapy designs have been demonstrated in multiple randomized controlled studies, oftentimes comparing an investigational device to an existing commercial therapy. In the real-world setting, data are lacking regarding selection of spinal cord stimulation (SCS) therapy, as waveform, pulse trains, and programming are not interchangeable among the devices. The purpose of this study is to help dissect a methodology for a patient centric multisystem trialing. We conducted a single center, retrospective, open label observational chart review. Between June 2017 and June 2019, 83 patients underwent SCS trials. Devices from four commercially available systems were trialed. Patients were given the opportunity to trial up to three systems. If the patient reported 50% or more pain relief/functional improvement with the trial, they were able to choose which system they liked best and proceed with implantation. There were 82% (68/83) of patients who proceeded to permanent implant, with 72 patients electing to trial more than one stimulation paradigm. Of those, 62 trialed 2 SCS systems, whereas 11 trialed 3. During the SCS trials, loss of efficacy due to lead migration was 1.2% (1/83) and no infections occurred. The average pain score measured on the numeric pain rating scale (NRS), improved from 6.8 at baseline to 2.9 after implantation. Multisystem trialing is safe and effective in providing patients increased exposure to multiple commercially available SCS systems.

Sacral Nerve Stimulation Lead Migration through the Sciatic Foramen, Successfully Repositioned

Introduction: SNS (Sacral Nerve Stimulation) has become an established minimally invasive procedure for urinary and faecal incontinence. Minor complications related to the procedure are common; include pain, infection or migration. We present a case of a tined lead migration through the sciatic foramen. Case Report: A 72-year-old woman with faecal incontinence, who did not respond to dietary of medical treatment, underwent a sacral nerve stimulation test. Under fluoroscopic vision a tined lead was placed in S3 foramen, with an adequate motor and sensory response. In the 7th postoperative day, she reported no improvement and she referred sensory response in the thigh and leg. Radiography showed migration of the electrode through the sciatic foramen. The repositioning of the same electrode was possible with a gentle traction of the lead. Correct placement of the lead was confirmed radiologically, and the patient showed motor and sensory response in the anal area. The patient improved Wexner score from 18/20 to 4/20. Conclusion: Migration of the tined lead should be considered if loss of response in found. Repositioning of the same lead is possible in selected patients, without the need of removal of the device.

Targeting of the Subthalamic Nucleus in Patients with Parkinson's Disease Undergoing Deep Brain Stimulation Surgery.

Precise stereotactic targeting of the dorsolateral motor part of the subthalamic nucleus (STN) is paramount for maximizing clinical effectiveness and preventing side effects of deep brain stimulation (DBS) in patients with advanced Parkinson’s disease. With recent developments in magnetic resonance imaging (MRI) techniques, direct targeting of the dorsolateral part of the STN is now feasible, together with visualization of the motor fibers in the nearby internal capsule. However, clinically relevant discrepancies were reported when comparing STN borders on MRI to electrophysiological STN borders during microelectrode recordings (MER). Also, one should take into account the possibility of a 3D inaccuracy of up to 2 mm of the applied stereotactic technique. Pneumocephalus and image fusion errors may further increase implantation inaccuracy. Even when implantation has been successful, suboptimal lead anchoring on the skull may cause lead migration during follow-up. Meticulous pre- and intraoperative imaging is therefore indispensable, and so is postoperative imaging when the effects of DBS deteriorate during follow-up. Thus far, most DBS centers employ MRI targeting, multichannel MER, and awake test stimulation in STN surgery, but randomized trials comparing surgery under local versus general anesthesia and additional studies comparing MER-STN borders to high-field MRI-STN may change this clinical practice. Further developments in imaging protocols and improvements in image fusion processes are needed to optimize placement of DBS leads in the dorsolateral motor part of the STN in Parkinson’s disease.

A Retrospective Review of Lead Migration Rate in Patients Permanently Implanted with Percutaneous Leads and a 10 kHz SCS Device.

Background Spinal cord stimulation (SCS) has been used over decades for pain management, but migration of percutaneous leads has been the most common complication. Better surgical techniques and newer SCS technologies likely reduced the incidence of lead migration requiring surgical revision, although data are sparse. This study aimed to retrospectively evaluate the incidence of clinically significant percutaneous lead migration in patients permanently implanted with a 10 kHz SCS system. Methods Consecutive patients with chronic trunk and/or limb pain, permanently implanted between January 2016 and June 2019, were included in the analysis. Data were collected from the hospital's electronic medical records and the manufacturer's database. Clinically significant lead migration, defined as diminished pain relief followed by surgery to correct lead location, was assessed at the 6-month follow-up. Results At the 6-month follow-up, there were no cases of clinically significant lead migration, average pain relief was 65.2%, 82% of patients had response (≥50% pain relief), improvement of function was noted in 72% of patients, and decrease of medication was observed in 42% of patients. Therapy efficacy was sustained in patients with >12 months follow-up; the average pain relief was 58.5%, and the response rate was 82%. Conclusions The surgical techniques in use today are designed to minimise the risk of percutaneous lead migration and may have reduced its incidence. In addition, new SCS systems may give greater opportunity to mitigate cases of minor lead movement using alternative stimulation programs.

Spinal Cord Stimulation for Chronic Refractory Neuropathic Pain: A Technical Note Initial Experience of Two cases

AbstractSpinal cord stimulation is an established procedure for relieving chronic neuropathic pain conditions. Although it has been over five decades since the first spinal cord stimulation (SCS) was developed, it has only been used in a few cases in India. It is primarily based on the “Gate Theory” of pain. The mechanism of its action is not exactly clear, but reports have suggested that it plays the main role in selectively stimulating the large diameter pain fibers in the dorsal aspect of spinal cord. SCS procedure involves a very careful case selection, and current evidence suggests that only a few conditions of chronic refractory neuropathic pain are its established indications. In these patients too, the efficacy rate remains around 50 to 75%. The overall pain relief observed is around 50% decrease in visual analog scale (VAS) scores. It is a technically simple procedure involving placement of electrodes over the dorsal aspect of spinal cord in the epidural space. The procedure is a staged one in which trial lead electrodes are first implanted and stimulated with an external pulse generator (EPG). If the trial is successful and patient has acceptable pain relief over 1 week of stimulation at various settings, the patient undergoes the permanent implantation of electrodes at the same position. The permanent electrodes are then stimulated by an implantable pulse generator (IPG) in the subcutaneous pocket (abdominal or gluteal). Complications are rare and are more related to hardware like lead migration and breakage. Since it is does not damage the cord per se, its acceptance as a procedure for pain is known quite well in the Western world. Its availability and cost of implants is the major hurdle in its use in a developing nation like India. Here, we present a technical note and our experience of two cases of thoracic spinal cord stimulation for chronic neuropathic pain at our institution.

Lead release kinetics and film transformation of Pb-MnO2 pre-coated anode in long-term zinc electrowinning

Lead pollution precaution caused by lead-based anode corrosion is a hot and challenging issue for zinc electrowinning. A novel functional lead-based anode (MnO2 pre-coated anode-MPA) was precisely fabricated and its long-term performances were studied compared with typical Pb−1%Ag anode (TPA). Results indicated that MPA posed excellent effects on synergistic inhibiting lead dissolution and reducing hazardous pollutants generation, and decreasing the lead content of zinc products by 81%. Further, the underlying mechanism of film growth and transformation in structure, composition and crystal phase, the migration and distribution of lead and anode slime during electrolytic, were clarified in-depth. Dynamic material flow analysis confirmed that MPA reduced the entire lead migration amount by over 92% compared with TPA. The compact multilayer structure of the MPA film and self-reparation effects of local structure provided better and persistent protection for the lead matrix, which greatly retarded the high-speed corrosion of lead anode. Compared with α-MnO2 in TPA, the formation and maintenance of γ-MnO2 in MPA accelerated the oxygen evolution reaction and inhibited the anode slime generation. This finding provides new insights in pollution precaution and control by designing and tuning new functional anode in hydrometallurgy process.

In Reply to the Letter to the Editor Regarding “First Report of Extraspinal Lead Migration Along a Thoracic Spinal Nerve After Spinal Cord Stimulation”

In Reply to the Letter to the Editor Regarding “First Report of Extraspinal Lead Migration Along a Thoracic Spinal Nerve After Spinal Cord Stimulation”

Letter to the Editor Regarding “First Report of Extraspinal Lead Migration Along a Thoracic Spinal Nerve After Spinal Cord Stimulation”

Letter to the Editor Regarding “First Report of Extraspinal Lead Migration Along a Thoracic Spinal Nerve After Spinal Cord Stimulation”