Spinal Cord Stimulators’ Displacement: Systematic Review and Single-Institution Case Series with Anchoring Technique

Rachael Mariadas,1 Elizabeth Pan,2 Tillman W Boesel,1 Antonio Di Ieva1,2 1Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, 2109, Australia; 2Computational NeuroSurgery (CNS) Lab, Macquarie Medical School, Macquarie University, Sydney, NSW, 2109, AustraliaCorrespondence: Antonio Di Ieva, Email [email protected]: Spinal cord stimulation (SCS) is an established neuromodulation therapy for chronic pain, but lead displacement remains a frequent hardware complication with important implications for long-term efficacy. This systematic review quantifies electrode displacement rates worldwide and evaluates whether a spine-anchoring technique is associated with reduced displacement via a single-institution case series.Materials and Methods: A systematic review was conducted in MEDLINE, Embase, and Cochrane Central (1967–February 2024) to identify SCS studies reporting lead displacement. The protocol was registered prospectively (PROSPERO CRD42024536758). Methodological quality was assessed using the Newcastle–Ottawa Scale (NOS), the Cochrane risk-of-bias tools, and the GRADE approach. In parallel, a single-institution retrospective case series (2017– 2024) included 128 chronic pain patients treated with SCS using an open surgical laminar anchoring technique with mini-plate and screw fixation.Results: The review included 117 articles (20,427 participants). Trial lead displacement occurred in 7.33% of patients (113/1,542), and permanent lead displacement in 6.64% (1,309/19,677). Studies judged at low risk of bias reported a permanent displacement rate of 2.1% versus 7.1% in high-risk studies. In the institutional case series, all 128 patients underwent a 7– 10-day trial, and 125 proceeded to permanent implantation. Trial displacement was 0% (0/128), and permanent displacement was 2.4% (3/125). All three displaced leads showed cranio‑caudal migration and ultimately required surgical revision after unsuccessful reprogramming; all revisions were successful, with no recurrent displacement.Conclusion: Heterogeneity in study design and reporting limits direct comparison of displacement rates across the literature, but methodological quality clearly influences reported outcomes. The open laminar anchoring technique used at our institution was associated with a 2.4% permanent displacement rate, lower than many historical estimates and comparable to rates in lower-risk studies, suggesting that robust anchoring strategies may reduce clinically important lead displacement in selected chronic pain populations.Keywords: spinal cord stimulation, lead displacement, anchoring technique, chronic pain, systematic review, lead migration, surgical technique