Occipital Nerve Stimulator Lead Pathway Length Changes with Volunteer Movement: An In Vitro Study

Background: Occipital nerve stimulation is a modality reserved for refractory headache disorders. Leads (wires) are inserted subcutaneously in the occipital region to stimulate the distal C1‐3 nerves; lead migration may result from repeated mechanical forces on the lead associated with patient move...

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Bibliographic Details
Published in:	Pain practice Vol. 10; no. 1; pp. 42 - 48
Main Authors:	Trentman, Terrence L., Mueller, Jeff T., Shah, Deepesh M., Zimmerman, Richard S., Noble, Brie M.
Format:	Journal Article
Language:	English
Published:	Malden, USA Blackwell Publishing Inc 01-01-2010
Subjects:	Adult complications Electric Stimulation Therapy - adverse effects Electric Stimulation Therapy - instrumentation Electric Stimulation Therapy - methods Electrodes, Implanted - adverse effects Female headache Headache Disorders - etiology Headache Disorders - physiopathology Human Experimentation Humans implantation Male Models, Neurological Movement - physiology Neural Pathways - physiology Occipital Lobe - physiology occipital nerve stimulation Postoperative Complications - etiology Postoperative Complications - physiopathology Scalp - innervation Spinal Nerves - physiology
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Summary:	Background: Occipital nerve stimulation is a modality reserved for refractory headache disorders. Leads (wires) are inserted subcutaneously in the occipital region to stimulate the distal C1‐3 nerves; lead migration may result from repeated mechanical forces on the lead associated with patient movement. The primary aim of this study was to determine implantation pathways associated with the least pathway length change secondary to body movement in an in vitro model of an occipital stimulator system. Methods: After institutional review board approval, 10 volunteers were recruited. The expected pathway of an occipital stimulator system was identified and measured externally, and then changes in pathway length were measured during various volunteer movements, including neck and low back flexion, extension, rotation, and lateral flexion. The pathways studied included those that connect internal pulse generators in the gluteal, low abdominal, and infraclavicular regions to occipital leads inserted via a cervical or retromastoid approach. Results: The flexion/extension pathway length changes associated with midline occipital and retromastoid sites to the infraclavicular site were significantly less than those pathways to the periscapular site. Also, the abdominal site was associated with less pathway length change during flexion/extension than the gluteal site. Conclusions: Internal pulse generators in sites other than the buttock, including infraclavicular or low abdomen, may be associated with lower lead migration risk. There are many considerations when selecting insertion sites and lead pathways for occipital nerve stimulation. Implanters and patients may consider these results when contemplating surgical approaches to this challenging form of peripheral nerve stimulation.
Bibliography:	ark:/67375/WNG-ZF1HHN1L-V ArticleID:PAPR328 istex:D1D1063FFE161653BEF67527118C1C4CF5754BEA Meetings where work has been presented: none. Research support: This study was supported by a research grant from Mayo Clinic Arizona. Reprints will not be available from the author. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	1530-7085 1533-2500
DOI:	10.1111/j.1533-2500.2009.00328.x