Stimulation of the Spinal Cord by Placement of Surgical-Based Paddle Leads

Abstract

Spinal cord stimulation can be achieved through various methods. One of the least invasive and most popular options is percutaneous lead placement via a needle in the epidural space and passing a cylindrical lead into the desired epidural location, producing circumferential modulation of surrounding structures of the neuroaxis. Percutaneous implantation of leads is favored by the majority of interventional pain physicians and is a common method of performing most trials and many permanent implants. An increasingly common method of placing the permanent spinal cord stimulation leads is via an open surgical technique in which a small laminotomy is performed, allowing a ribbon-type surgical or paddle lead to be placed in an antegrade or retrograde fashion into the epidural space under direct visualization. The paddle lead allows for a more efficient, unidirectional lead that may offer more stability. Paddle leads are indicated based on surgeon preference as well as other clinical factors detailed in Table 8.1.