Lead Migration Following Sacral Neuromodulation Implantation: Contemporary Real-World Experience From a High-Volume Academic Center.

Abstract

Introduction: Lead migration is a recognized cause of recurrent symptoms and revision following sacral neuromodulation (SNM), yet its radiographic characteristics and associated risk factors remain poorly defined. We evaluated postoperative sacral imaging obtained for suspected lead migration to characterize migration patterns and to identify factors independently associated with lead migration in a contemporary cohort of patients undergoing SNM implantation.

Materials and methods: We performed a retrospective review of all patients undergoing SNM implantation at a tertiary academic referral center between September 2019 and June 2025. Lead migration was assessed by comparing baseline intraoperative fluoroscopic images with follow-up radiographs using a standardized radiographic measurement protocol.

Results: Among 445 patients undergoing SNM implantation, 173 met at least one predefined indication for postoperative imaging. Ninety-two had both baseline and follow-up imaging available for quantitative assessment. Overall, 35/445 (7.86%) patients had confirmed lead migration. Migration occurred predominantly in the forward direction (62.9%), with a median time to migration of 16 months (interquartile range, 7-28 months). A total of 29/35 patients (82.9%) underwent surgical revision or device removal. On Firth bias-reduced multivariable logistic regression analysis, Axonics devices were associated with higher odds of lead migration compared with Medtronic devices (adjusted odds ratio [aOR], 2.66; 95% confidence interval [CI], 1.09-6.62; p = 0.031), after adjustment for implantation approach, rechargeable device status, BMI, and age-adjusted CCI. Massive migration (> 21 mm) occurred only in Axonics devices.

Conclusions: Lead migration following SNM implantation was uncommon but frequently resulted in surgical intervention. Axonics devices were associated with higher odds of lead migration after adjustment for selected clinical and device-related factors. Importantly given the relatively small number of migration events and retrospective study design, this finding should be considered hypothesis-generating rather than evidence of a causal association. Prospective multicenter studies are warranted to validate these findings and further define the mechanisms and clinical significance of SNM lead migration.