Study Overview
A 2026 study published in Pain Practice: The Official Journal of the World Institute of Pain evaluated the clinical implications of preoperative thoracic spine magnetic resonance imaging (MRI) for patients undergoing percutaneous spinal cord stimulation (SCS) lead placement. Conducted at a single center between January 2020 and March 2023, the retrospective analysis included 167 patients who underwent MR imaging prior to SCS procedures. The study excluded cases involving lead revisions or cervical/dorsal root lead placements. Researchers aimed to assess how MRI findings influenced procedural planning and execution, categorizing outcomes as minor (e.g., additional imaging) or major (e.g., procedure cancellation).
Key Findings
Of the 167 patients, 129 proceeded with SCS lead placement, while the remaining 38 did not due to patient/physician preference for conservative treatment. MRI revealed abnormalities in 58 patients, with 22 involving the epidural space and 36 being incidental findings. Among these, 29 patients (17.4% of total) had abnormalities with no clinical consequences. Minor consequences occurred in 23 patients (13.8%), while major consequences affected 6 patients (3.6%). Major impacts included one case of primary surgical implantation, two changes in epidural entry levels, two surgical decompressions, and one procedure cancellation. Notably, 48.2% of MRI findings with clinical implications were not visible on prior imaging, all located in the thoracic region.
Clinical Implications
The study highlights that routine preoperative thoracic spine MRI identifies abnormalities with significant procedural impacts in 3.6% of cases. While some findings required adjustments to surgical plans, the authors note no statistically significant association between epidural abnormalities and periprocedural complications such as dural puncture or improper lead positioning. This suggests that while MRI can uncover critical anatomical variations, its predictive value for procedural risks remains uncertain. The findings emphasize the importance of preoperative imaging in identifying anatomical challenges but also underscore the need for further research to clarify its role in preventing complications during SCS procedures.
Limitations
The study acknowledges several limitations, including its retrospective design and lack of power to specifically evaluate the correlation between epidural abnormalities and procedural complications. The authors caution that the absence of a significant association does not rule out potential clinical relevance, as the sample size and study parameters may have constrained the analysis. Additionally, the exclusion of lead revisions and non-thoracic placements limits the generalizability of results to broader SCS applications. The authors recommend prospective studies to better define the clinical utility of preoperative MRI in SCS planning.
Conclusion
This study provides evidence that preoperative thoracic spine MRI frequently identifies abnormalities with major clinical implications in a small subset of patients undergoing SCS lead placement. While the majority of findings had no immediate impact on procedures, the detection of thoracic region abnormalities not visible on prior imaging highlights the potential value of routine MRI. However, the lack of a clear link between epidural abnormalities and procedural complications suggests that the role of preoperative imaging in SCS remains complex. The authors emphasize the need for further investigation to determine how best to integrate imaging findings into clinical decision-making for spinal cord stimulation procedures.