Anticipating and preventing complications in spinal cord stimulator implantation

Falowski, Steven; Tan, Hao; Parks, Joseph; Abd‐Elsayed, Alaa; Raslan, Ahmed M.; Pope, Jason E.

doi:10.1080/17434440.2023.2196399

Expert Review of Medical Devices

2023

DOI: 10.1080/17434440.2023.2196399

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Anticipating and preventing complications in spinal cord stimulator implantation

Steven Falowski

Hao Tan

Joseph Parks

et al.

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Cited by 2 publications

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“…7,11 Disadvantages to thoracic laminotomy include the need for general anesthesia and placement of a larger epidural device with a potential higher risk of neurologic deficit from spinal cord compression. 11,15 Reported rates of neurologic deficit after thoracic SCS paddle lead implantation are 0.54%-1.71%, 12,[14][15][16][17][18] although some believe the incidence of neurologic complications is under-reported. 14,15 To avoid deficits, the Neuromodulation Appropriateness Consensus Committee (NACC) has recommended preoperative thoracic imaging to assess for compressive pathology.…”

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confidence: 99%

Analysis of spinal canal diameter in the placement of thoracic spinal cord stimulator paddle leads

Ragel,

Riedman,

McGehee

et al. 2023

Pain Practice

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BackgroundNeurologic deficit is known as a rare complication of thoracic spinal cord stimulator (SCS) paddle lead implantation, but many believe its incidence after SCS paddle lead placement is under‐reported. It is possible that imaging characteristics may be used to help predict safe paddle lead placement.ObjectiveThis imaging study was undertaken to determine the minimum canal diameter required for safe paddle lead placement.MethodsPatients who underwent thoracic laminotomy for new SCS paddle lead placement from January 2018 to March 2023 were identified retrospectively. Preoperative thoracic canal diameter was measured in the sagittal plane perpendicular to the disc space from T5/6 to T11/12. These thoracic levels were chosen because they span the most common levels targeted for SCS placement. Patients with and without new neurologic deficits were compared using a Mann–Whitney U‐test.ResultsOf 185 patients initially identified, 180 had thoracic imaging available for review. One (0.5%) and 2 (1.1%) of 185 patients complained of permanent and transient neurologic deficit after thoracic SCS placement, respectively. Patients with neurologic deficits had average canal diameters of <11 mm. The average canal diameter of patients with and without neurologic deficits was 10.2 mm (range 6.1–12.9 mm) and 13.0 mm (range 5.9–20.2), respectively (p < 0.0001).ConclusionPostoperative neurologic deficit is an uncommon complication after thoracic laminotomy for SCS paddle lead placement. The authors recommend ensuring a starting thoracic canal diameter of at least 12 mm to accommodate a SCS paddle lead measuring 2 mm thick to ensure a final diameter of >10 mm. If canal diameter is <12 mm, aggressive undercutting of the lamina, a second laminotomy, or placement of smaller SCS wire leads should be considered.

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confidence: 99%

Analysis of spinal canal diameter in the placement of thoracic spinal cord stimulator paddle leads

Ragel,

Riedman,

McGehee

et al. 2023

Pain Practice

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Spinal Cord Stimulation Waveforms for the Treatment of Chronic Pain

Chitneni,

Jain,

Sahni

et al. 2024

Curr Pain Headache Rep

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Anticipating and preventing complications in spinal cord stimulator implantation

Cited by 2 publications

References 40 publications

Analysis of spinal canal diameter in the placement of thoracic spinal cord stimulator paddle leads

Analysis of spinal canal diameter in the placement of thoracic spinal cord stimulator paddle leads

Spinal Cord Stimulation Waveforms for the Treatment of Chronic Pain

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