Open AccessOccipital Neurostimulation-Induced Muscle Spasms: Implications for Lead Placement
Author(s) -
Salim M. Hayek,
Joseph F. Jasper,
Timothy R. Deer,
Samer Narouze
Publication year - 2009
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2009/12/867
Subject(s) - medicine , muscle spasm , neurostimulation , occipital nerve stimulation , headaches , lead (geology) , cervicogenic headache , anesthesia , stimulation , surgery , migraine , alternative medicine , pathology , geomorphology , geology
Background: For many headache types, occipital peripheral nerve stimulation (ONS)provides significant relief of chronic, frequent, and severe headaches. Though rarely reported,ONS may cause painful muscle spasms that make stimulator use impractical. The classicdescription of the technique advocates placement of the leads transversely at the level of thearch of C1 or at C1-2. At that level, the greater occipital nerve (GON) infrequently pierces thesuperficial fascia of the neck muscles to become superficial. However, important anatomicvariability exists.Objective: To report placement of leads higher at the nuchal line rather than the classicallyrecommended C1 level to avoid ONS-induced muscle spasm.Methods: Four interventional pain physicians independently revised ONS leads due topainful muscle stimulation. Five case reports of surgical ONS lead revision for management ofONS-induced muscle spasms are described and discussed.Results: Placement of peripheral neurostimulator leads at or above the nuchal line in these5 cases provided good paresthesiae without causing neck muscle spasm.Conclusion: Lead placement at the level of C1 or C1-2 may cause some patients to haveintolerable neck/occipital spasm during neurostimulation. This is the first known publishedreport of technical variation in the location of lead placement, at the nuchal line in a transversefashion, for ONS. Placing ONS leads at the level of the occipital protuberance appears toeliminate ONS-induced muscle spasm while allowing good paresthesia coverage.Limitations: Stimulation parameters vary, thus posting parameters may be misleading asmuscle spasms occurred despite multiple reprogramming attempts and were a function oflead position, not program settings.Key words: Occipital nerve stimulator, peripheral neurostimulation, muscle spasm,complication, interventional pain management, cephalgia, headache, migraine, occipitalneuralgia, greater occipital nerve