Dorsal paddle leads implant for spinal cord stimulation through laminotomy with midline structures preservation

Abstract

Background:Pain relief obtained with spinal cord stimulation (SCS) in failed back surgery syndrome (FBSS) has been shown to be more effective with paddle leads than with percutaneous catheters. A laminectomy is generally required to implant the paddles, but the surgical approach may lead to iatrogenic spinal instability in flexion. In contrast, clinical and experimental data showed that a laminotomy performed through flavectomy and minimal resection of inferior and superior lamina with preservation of the midline ligamentous structures allowed to prevent iatrogenic instability. Aim of the study was to assess degree of instability and pain level in patients operated for SCS through laminectomy or laminotomy with midline structures integrity. The surgical technique is described and our preliminary results are discussed.Methods:Nineteen patients with FBSS underwent SCS, 12 through laminectomy and 7 through uni- or bilateral interlaminotomy with supraspinous ligament preservation. Postoperative local pain was evaluated at 15, 30, and 60 days. Static and dynamic X-rays were performed after 2 months.Results:The techniques allowed implanting the paddle leads in all cases. No intraoperative complications occurred. Local pain was higher and recovery time was longer in patients with laminectomy. We did not observe radiological signs of postoperative iatrogenic vertebral instability. Nevertheless, two patients who underwent laminectomy showed persistence of local pain after 2 months probably due to pathologic compensatory stability provided by the paraspinal musculature.Conclusions:The laminotomy is a minimally invasive approach that ensures rapid recovery after surgery, spinal functional integrity, and complete reversibility. Further studies are needed to confirm our preliminary results.

Development of a Modified Bayonet Forceps for Improving Steerability of Paddle Lead Electrodes During Spinal Cord Stimulator Surgery: A Technical Note

“…Some surgeons have described midline minimally invasive techniques, 40 whereas others have proposed unilateral or bilateral laminotomies (with preservation of the spinous process and interspinous ligaments) to improve postoperative pain and minimize soft tissue disruption. 10 However, to our knowledge, no previous study has described surgical instrumentation modifications to improve SCS implantation. The reality is that, when performing SCS implants, the majority of spine surgeons use instruments designed for other purposes.…”

“…Currently, SCS paddle lead placement is somewhat hindered by inherent limitations of existing surgical instrumentation, which may be associated with prolonged operative time, 9,10 need for multiple passes, and, ultimately, increased risk of complications. 6,7,9,11 In this brief technical note, we introduce a modified bayonet forceps which enables surgeons to place paddle leads in a more efficient and technically elegant manner.…”

Should Posterior Midline Structures Be Preserved in Decompression Surgery for Lumbar Spinal Stenosis?

“…13 In theory, a laminotomy performed through flavectomy and minimal resection of the inferior and superior lamina with preservation of the midline ligamentous structures allowed to prevent iatrogenic instability. 26 As narrowing of the spinal canal occurs predominantly at the interlaminar region involving the arthrosis of the facet joints and bulging of the intervertebral disk and the ligamentum flavum, resection of the whole vertebral arch may not be necessary. 13 In contrast, biomechanical study suggests that to preserve the midline structures may have a deleterious effect upon the anatomic structures responsible for the stability of the lumbar spine.…”

“…PO instability is thought to be an important cause of low back pain and is considered an indication for salvage surgery with concomitant instrumented fusion 13. In theory, a laminotomy performed through flavectomy and minimal resection of the inferior and superior lamina with preservation of the midline ligamentous structures allowed to prevent iatrogenic instability 26. As narrowing of the spinal canal occurs predominantly at the interlaminar region involving the arthrosis of the facet joints and bulging of the intervertebral disk and the ligamentum flavum, resection of the whole vertebral arch may not be necessary 13.…”

Efficacy analysis of two surgical treatments for thoracic and lumbar intraspinal tumours

“…Shimazaki K reported that recurrence of spinal stenosis and claudication after laminectomy due to an ossified extradural pseudocyst [15]. A study by Mearini demonstrated that local pain was higher and recovery time was longer in patients with laminectomy [16]. Laminoplasty can reduce the occurrence of these conditions [14].…”