Migration of a Dorsal Root Ganglion Stimulation Electrode Into the Mediastinum: A Clinical Case Study.

INTRODUCTION

Dorsal root ganglion stimulation (DRGS) is a recognized treatment for chronic neuropathic pain. A well-known complication is electrode migration, which most commonly occurs in a caudal direction.

OBJECTIVE

To present a rare clinical case of cranial migration of a DRGS electrode into the mediastinum.

CASE PRESENTATION: A 62-year-old woman with pharmacoresistant intercostal neuralgia underwent DRGS electrode implantation at the Th2 level using a standard linear lead, as specialized DRGS electrodes were unavailable. Initial therapy was effective. However, follow-up imaging approximately two years post implantation revealed that the electrode had migrated cranially through the Th2-Th3 intervertebral foramen. The tip was located in the mediastinum, in immediate proximity to the right subclavian artery, creating a significant risk of vascular or pleural injury. The electrode was successfully and safely explanted.

CONCLUSION

This is the first reported case of mediastinal migration of a DRGS electrode. It highlights the unique risks associated with off-label cranial DRGS applications due to anatomical constraints and gravitational forces. The case underscores the urgent need for the development and use of specialized electrodes designed for such locations and reinforces the importance of improved fixation techniques and long-term postoperative vigilance to mitigate migration risks.