Revision and Replacement of Spinal Cord Stimulator Paddle Leads

Harland, Tessa A.; Topp, G; Shao, Kevin; Pilitsis, Julie G.

doi:10.1016/j.neurom.2022.02.228

Cited by 11 publications

(6 citation statements)

References 16 publications

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“…However, paddles implanted for more than 1 year may require full laminectomy to explant given the surrounding fibrosis. 23 The short term of the trials will not select the delayed responders and does select the delayed non-responders, i.e., patients that have a positive short-term trial and then, after the implant, lacks response, regardless of new waveforms or programming, as observed in peripheral nerve stimulation trials. 24 In selected cases, like patients with previous spinal canal decompression who commonly cannot undergo a percutaneous trial due to epidural scaring, paddle SCS could be the best option.…”

Section: Discussionmentioning

confidence: 99%

“…Recently implanted paddles are easily explanted because there is no fibrosis in between the lead cables. However, paddles implanted for more than 1 year may require full laminectomy to explant given the surrounding fibrosis 23 . The short term of the trials will not select the delayed responders and does select the delayed non‐responders, i.e., patients that have a positive short‐term trial and then, after the implant, lacks response, regardless of new waveforms or programming, as observed in peripheral nerve stimulation trials 24 .…”

Section: Discussionmentioning

confidence: 99%

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Retrograde thoracic spinal cord stimulation paddle placement for complex persistent spinal pain syndrome type 2

de Monaco,

Piedade,

Doomi

et al. 2023

Pain Practice

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BackgroundSpinal cord stimulation (SCS) is a cost‐effective option for treating refractory persistent spinal pain syndrome type‐2 (PSPS‐2). For patients with extensive spine instrumentation including the thoraco‐lumbar junction, percutaneous placement of SCS leads is usually not an option being paddle leads typically implanted anterograde. Paddle lead placement will be particularly challenging in more complex cases when the instrumentation covers the targeted level. To overcome this barrier, we studied using a retrograde approach to reach the sweet spot, facilitate the placement, and reduce associated risks.ObjectivesTo study the use of retrograde SCS paddle as a placement method to optimize the spinal cord target and reduce the risks of conventional placement in complex cases.Study DesignCase series and technical note.MethodsWe present three cases of thoracic retrograde SCS paddle lead placement cases, detailing patient selection, operative technique, and outcome. All the cases had extensive instrumentation to the thoraco‐lumbar spine, and one had additional spinal canal stenosis. The surgical procedure entailed a retrograde midthoracic inter‐laminar approach, flavectomy, and caudal placement of the paddle lead with intraoperative neurophysiologic monitoring (IONM) guidance for functional midline determination.ResultsAll the cases had a successful lead placement over the sweet spot without complications. The same approach was used to decompress a focal spinal stenosis in one case. One case had significantly improved pain and hence underwent a pulse generator implant. The other cases had non‐satisfactory pain control and were explanted.LimitationsThese case description could guide technical procedural steps, however, a larger number of such cases would be needed to describe further technical nuances.ConclusionsWe demonstrated that placing SCS paddle leads via retrograde midthoracic approach with IONM guidance is safe. This procedure should be an option for SCS paddle implants in patients with posterior spinal fusion encompassing the intended targeted spinal stimulation level.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Retrograde thoracic spinal cord stimulation paddle placement for complex persistent spinal pain syndrome type 2

de Monaco,

Piedade,

Doomi

et al. 2023

Pain Practice

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“…34,[62][63][64][65][66][67] In cases where scarring is present or anatomy prevents safe passage, a laminectomy or skip laminotomy may be performed. 68 Cervical lead placement involves both anterograde and retrograde cervical paddles. 69 The incision can either be made near the laminectomy site and the paddle threaded upward to C2 or be made to expose the foramen magnum and arch of C1.…”

Section: Paddle Leadsmentioning

confidence: 99%

“…Scarring also makes the dura more sensitive to any pressure with instruments, and IONM is paramount. 68…”

Section: Paddle Leadsmentioning

confidence: 99%

The Evolution of Surgical Technique in Spinal Cord Stimulation: A Scoping Review

Bean,

Goon,

McClure

et al. 2023

Operative Neurosurgery

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Since the advent of spinal cord stimulation (SCS), its operative technique has consistently advanced. We performed a scoping review of the literature regarding SCS operative techniques to highlight key advancements. To review, summarize, and highlight key changes in SCS implantation techniques since their inception. The authors performed a MEDLINE search inclusive of articles from 1967 to June 2023 including human and modeling studies written in English examining the role of trialing, intraoperative neuromonitoring, and surgical adaptations. Using the Rayyan platform, two reviewers performed a blinded title screen. Of the 960 articles, 197 were included in the title screen, 107 were included in the abstract review, and ultimately 69 articles met inclusion criteria. We examined the utility of trialing and found that historical controls showed significant efficacy, whereas recent results are more equivocal. We discuss the significant improvement in outcomes with intraoperative neuromonitoring for asleep SCS placement. We highlight technique improvements that led to significant reductions in infection, lead migration, and inadequate pain relief. Physicians implanting SCS systems for chronic pain management must continually refine their surgical techniques to keep up with this rapidly evolving therapy. In addition, through collaborative efforts of neuromodulators and industry, SCS is safer and more effective for patients suffering from chronic pain.

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“…The first clinical question is whether SCS with a paddle-type lead placed on the rostral side of the SCI provides more pain relief. A paddle-type lead device can deliver energy more efficiently than a cylinder-type lead device, although laminectomy is necessary for paddle-type lead placement [ 26 – 28 ].…”

Section: Introductionmentioning

confidence: 99%

Differential target multiplexed spinal cord stimulation using a paddle-type lead placed at the appropriate site for neuropathic pain after spinal cord injury in patients with past spinal surgical histories: study protocol for an exploratory clinical trial

Tanei¹,

Maesawa²,

Nishimura³

et al. 2023

Trials

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Background Neuropathic pain after spinal cord injury (SCI), both traumatic and non-traumatic, is refractory to various treatments. Spinal cord stimulation (SCS) is one of the neuromodulation therapies for neuropathic pain, although SCS has insufficient efficacy for neuropathic pain after SCI. The reasons are presumed to be inappropriate locations of SCS leads and conventional tonic stimulation itself does not have a sufficient analgesic effect for the pain. In patients with past spinal surgical histories, the cylinder-type leads are likely to be placed on the caudal side of the SCI because of surgical adhesions. Differential target multiplexed (DTM) stimulation is one of the latest new stimulation patterns that is superior to conventional stimulation. Methods A single-center, open-label, randomized, two-way crossover trial is planned to investigate the efficacy of SCS using DTM stimulation placing a paddle lead at the appropriate site for neuropathic pain after SCI in patients with spinal surgical histories. The paddle-type lead delivers energy more efficiently than a cylinder-type lead. This study consists of two steps: SCS trial (first step) and SCS system implantation (second step). The primary outcome is rates of achieving pain improvement with more than 33% reduction 3 months after SCS system implantation. The secondary outcomes are to be evaluated as follows: (1) effectiveness of DTM and tonic stimulations during the SCS trial; (2) changes of assessment items from 1 to 24 months; (3) relationships between the result of the SCS trial and the effects 3 months after SCS system implantation; (4) preoperative factors associated with a long-term effect, defined as continuing for more than 12 months; and (5) whether gait function improves from 1 to 24 months. Discussion A paddle-type lead placed on the rostral side of SCI and using DTM stimulation may provide significant pain relief for patients with intractable neuropathic pain after SCI in patients with past spinal surgical histories. Trial registration Japan Registry of Clinical Trials (jRCT) jRCT 1042220093. Registered on 21 November 2022, and last modified on 6 January 2023. jRCT is approved as a member of the Primary Registry Network of WHO ICTRP.

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Revision and Replacement of Spinal Cord Stimulator Paddle Leads

Cited by 11 publications

References 16 publications

Retrograde thoracic spinal cord stimulation paddle placement for complex persistent spinal pain syndrome type 2

Retrograde thoracic spinal cord stimulation paddle placement for complex persistent spinal pain syndrome type 2

The Evolution of Surgical Technique in Spinal Cord Stimulation: A Scoping Review

Differential target multiplexed spinal cord stimulation using a paddle-type lead placed at the appropriate site for neuropathic pain after spinal cord injury in patients with past spinal surgical histories: study protocol for an exploratory clinical trial

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