Accuracy, Repeatability, and Reproducibility of a Radiographic Technique to Assess Spinal Cord Stimulation Lead Position: A Validation Study

Abstract

Spinal cord stimulation with implantable leads is a valuable therapy used to treat a variety of chronic pain conditions. However, lead migration is a common complication causing loss of efficacy. Previous reports have characterized lead migration using radiographs, but methods are not consistent and lack rigorous validation. The purpose of this study was to develop a technique to perform radiographic measurements of the position of epidural spinal cord leads within the lumbosacral spinal canal and establish its accuracy, repeatability, and reproducibility. Computed tomography scans were acquired from three clinical trial participants implanted percutaneously with two eight-contact cylindrical leads; from these, electrode positions were established using three-dimensional measurements, and digitally reconstructed radiographs were created. Two operators applied a digitization and measurement protocol for each lead. Bland-Altman plots were created to determine smallest detectable change, and a gage repeatability and reproducibility analysis was performed. Smallest detectable change was found to be less than the distance between adjacent electrodes and variability introduced by repeatability and reproducibility was less than 10% of the total study variability. We conclude that the method developed to measure lead electrode position has sufficient accuracy and acceptable repeatability and reproducibility.