Spinal Cord Stimulation Surgical Paddle Placement

Falowski, Steven

doi:10.1007/978-1-4939-6976-0_62

Cited by 1 publication

(6 citation statements)

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“…Many authors believe the incidence of neurologic complications after SCS placement is under-reported. 12,14,15,20 In this case series, one "severe neurologic injury" (0.5%, 1/185) and two cases of transient neurologic deficit (1.1%, 2/185) were encountered. This study was undertaken because of these three cases of neurologic deficit immediately after SCS paddle lead implantation; the results showed that the average canal diameter of patients with and without neurologic deficit differed significantly (p < 0.0001).…”

Section: Discussionmentioning

confidence: 64%

“…Many authors believe the incidence of neurologic complications after SCS placement is under‐reported 12,14,15,20 . In this case series, one “severe neurologic injury” (0.5%, 1/185) and two cases of transient neurologic deficit (1.1%, 2/185) were encountered.…”

Section: Discussionmentioning

confidence: 73%

“…The length of the paddle is important to ensure adequate decompression across all levels that the paddle passes and spans. Currently, paddle leads range from 33 to 64 mm in length and 7.6 to 13 mm in width 20 . To ensure adequate canal diameter, aggressive laminotomy techniques should be used (Figure 6).…”

Section: Discussionmentioning

confidence: 99%

“…Reported rates of neurologic deficit after thoracic SCS paddle lead implantation are 0.54%–1.71%, 12,14–18 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 12,14,15,19,20 . Thus, we aimed to define a minimum canal diameter to predict safe paddle lead placement by comparing thoracic canal diameters of patients with and without postoperative neurologic deficit.…”

Section: Introductionmentioning

confidence: 99%

“…14,15 To avoid deficits, the Neuromodulation Appropriateness Consensus Committee (NACC) has recommended preoperative thoracic imaging to assess for compressive pathology. 12,14,15,19,20 Thus, we aimed to define a minimum canal diameter to predict safe paddle lead placement by comparing thoracic canal diameters of patients with and without postoperative neurologic deficit.…”

mentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%