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Epidural Paddle Placement for Spinal Cord Stimulation

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Integrating Pain Treatment into Your Spine Practice

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Abstract

Spinal cord stimulation (SCS) is a widely used, effective modality for treating chronic pain. In the following chapter the authors attempt to discuss trends and reported literature on the utility and surgical technique of open epidural paddle electrode array placement. Pearls and pitfalls associated with the procedure are discussed for both cervical and thoracic implants. Various novel techniques from case reports in the literature are also reviewed in order to provide a concise update to implanting surgeons to ensure each electrode placement is straightforward, swift, and effective with minimal complications.

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References

  1. North RB, Kidd D, Shipley J, Taylor RS. Spinal cord stimulation versus reoperation for failed back surgery syndrome: a cost effectiveness and cost utility analysis based on a randomized, controlled trial. Neurosurgery. 2007;61(2):361–8. discussion 68–9.

    Article  PubMed  Google Scholar 

  2. North RB, Kidd DH, Farrokhi F, Piantadosi SA. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery. 2005;56(1):98–106. discussion 06–7.

    PubMed  Google Scholar 

  3. Lee AW, Pilitsis JG. Spinal cord stimulation: indications and outcomes. Neurosurg Focus. 2006;21(6), E3.

    PubMed  Google Scholar 

  4. Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain. 2007;132(1–2):179–88.

    Article  PubMed  Google Scholar 

  5. Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, et al. The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow-up of the prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation. Neurosurgery. 2008;63(4):762–70. discussion 70.

    Article  PubMed  Google Scholar 

  6. North RB, Kidd DH, Petrucci L, Dorsi MJ. Spinal cord stimulation electrode design: a prospective, randomized, controlled trial comparing percutaneous with laminectomy electrodes: part II-clinical outcomes. Neurosurgery. 2005;57(5):990–6. discussion 90–6.

    Article  PubMed  Google Scholar 

  7. North RB, Kidd DH, Olin JC, Sieracki JM. Spinal cord stimulation electrode design: prospective, randomized, controlled trial comparing percutaneous and laminectomy electrodes-part I: technical outcomes. Neurosurgery. 2002;51(2):381–9. discussion 89–90.

    PubMed  Google Scholar 

  8. North RB, Kidd D, Davis C, Olin J, Sieracki JM. Spinal cord stimulation electrode design: a prospective randomized, controlled trial comparing percutaneous and laminectomy electrodes. Stereotact Funct Neurosurg. 1999;73(1–4):134.

    Article  PubMed  Google Scholar 

  9. Mammis A, Mogilner AY. The use of intraoperative electrophysiology for the placement of spinal cord stimulator paddle leads under general anesthesia. Neurosurgery. 2012;70(2 Suppl Operative):230–6.

    PubMed  Google Scholar 

  10. Deer TR, Thomson S, Pope JE, Russo M, Luscombe F, Levy R. International neuromodulation society critical assessment: guideline review of implantable neurostimulation devices. Neuromodulation. 2014;17(7):678–85. discussion 85.

    Article  PubMed  Google Scholar 

  11. Holsheimer J, Nuttin B, King GW, Wesselink WA, Gybels JM, de Sutter P. Clinical evaluation of paresthesia steering with a new system for spinal cord stimulation. Neurosurgery. 1998;42(3):541–7. discussion 47–9.

    Article  CAS  PubMed  Google Scholar 

  12. Falowski S, Celii A, Sharan A. Spinal cord stimulation: an update. Neurotherapeutics. 2008;5(1):86–99.

    Article  PubMed  Google Scholar 

  13. Falowski S, Sharan A. A review on spinal cord stimulation. J Neurosurg Sci. 2012;56(4):287–98.

    CAS  PubMed  Google Scholar 

  14. North RB, Kidd DH, Olin J, Sieracki JM, Boulay M. Spinal cord stimulation with interleaved pulses: a randomized, controlled trial. Neuromodulation. 2007;10(4):349–57.

    Article  PubMed  Google Scholar 

  15. Falowski SM, Celii A, Sestokas AK, Schwartz DM, Matsumoto C, Sharan A. Awake vs. asleep placement of spinal cord stimulators: a cohort analysis of complications associated with placement. Neuromodulation. 2011;14(2):130–4. discussion 34–5.

    Article  PubMed  Google Scholar 

  16. Sarubbo S, Latini F, Tugnoli V, Quatrale R, Granieri E, Cavallo MA. Spinal anesthesia and minimal invasive laminotomy for paddle electrode placement in spinal cord stimulation: technical report and clinical results at long-term followup. ScientificWorldJournal. 2012;2012:201053.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Vangeneugden J. Implantation of surgical electrodes for spinal cord stimulation: classical midline laminotomy technique versus minimal invasive unilateral technique combined with spinal anaesthesia. Acta Neurochir Suppl. 2007;97(Pt 1):111–4.

    CAS  PubMed  Google Scholar 

  18. Air EL, Toczyl GR, Mandybur GT. Electrophysiologic monitoring for placement of laminectomy leads for spinal cord stimulation under general anesthesia. Neuromodulation. 2012;15(6):573–9. discussion 79–80.

    Article  PubMed  Google Scholar 

  19. Balzer JR, Tomycz ND, Crammond DJ, Habeych M, Thirumala PD, Urgo L, et al. Localization of cervical and cervicomedullary stimulation leads for pain treatment using median nerve somatosensory evoked potential collision testing. J Neurosurg. 2011;114(1):200–5.

    Article  PubMed  Google Scholar 

  20. Smith CC, Lin JL, Shokat M, Dosanjh SS, Casthely D. A report of paraparesis following spinal cord stimulator trial, implantation and revision. Pain Physician. 2010;13(4):357–63.

    PubMed  Google Scholar 

  21. Gilbert JW, Wheeler GR, Mick GE, Herder SL, Richardson GB. Paraparesis following spinal cord stimulator trial, implantation and revision. Pain Physician. 2010;13(6), E377.

    PubMed  Google Scholar 

  22. Levy R, Henderson J, Slavin K, Simpson BA, Barolat G, Shipley J, et al. Incidence and avoidance of neurologic complications with paddle type spinal cord stimulation leads. Neuromodulation. 2011;14(5):412–22. discussion 22.

    Article  PubMed  Google Scholar 

  23. Valle-Giler EP, Sulaiman WA. Midline minimally invasive placement of spinal cord stimulators: a technical note. Ochsner J. 2014;14(1):51–6.

    PubMed  PubMed Central  Google Scholar 

  24. MacDonald JD, Fisher KJ. Technique for steering spinal cord stimulator electrode. Neurosurgery. 2011;69(1 Suppl Operative):ons83–6. discussion ons86-7.

    PubMed  Google Scholar 

  25. Pabaney AH, Robin AM, Schwalb JM. New technique for open placement of paddle-type spinal cord stimulator electrode in presence of epidural scar tissue. Neuromodulation. 2014;17(8):759–62. discussion 62.

    Article  PubMed  Google Scholar 

  26. Robaina FJ, Dominguez M, Diaz M, Rodriguez JL, de Vera JA. Spinal cord stimulation for relief of chronic pain in vasospastic disorders of the upper limbs. Neurosurgery. 1989;24(1):63–7.

    Article  CAS  PubMed  Google Scholar 

  27. Amrani J. A novel technique for the implantation of paddle leads in the cervical spine. Neuromodulation. 2013;16(6):546–50. discussion 50.

    Article  PubMed  Google Scholar 

  28. Pahapill PA. Incidence of revision surgery in a large cohort of patients with thoracic surgical three-column paddle leads: a retrospective case review. Neuromodulation. 2015;18(5):367–75.

    Article  PubMed  Google Scholar 

  29. Penn DL, Zussman BM, Wu C, Sharan AD. Anterograde revision of cervical spinal cord stimulator paddle electrode: a case report. Neuromodulation. 2012;15(6):581–4. discussion 84–5.

    Article  PubMed  Google Scholar 

  30. Chivukula S, Tomycz ND, Moossy JJ. Paddle lead cervical spinal cord stimulation for failed neck surgery syndrome. Clin Neurol Neurosurg. 2013;115(10):2254–6.

    Article  PubMed  Google Scholar 

  31. Rosenow JM, Stanton-Hicks M, Rezai AR, Henderson JM. Failure modes of spinal cord stimulation hardware. J Neurosurg Spine. 2006;5(3):183–90.

    Article  PubMed  Google Scholar 

  32. Moens M, De Smedt A, Brouns R, Spapen H, Droogmans S, Duerinck J, et al. Retrograde C0-C1 insertion of cervical plate electrode for chronic intractable neck and arm pain. World Neurosurg. 2011;76(3–4):352–4. discussion 268–9.

    Article  PubMed  Google Scholar 

  33. Pahapill PA. A novel nonanchoring technique for implantation of paddle leads in the cervical spine under conscious sedation. Neuromodulation. 2015;18(6):472–6.

    Article  PubMed  Google Scholar 

  34. Whitworth LA, Feler CA. C1-C2 sublaminar insertion of paddle leads for the management of chronic painful conditions of the upper extremity. Neuromodulation. 2003;6(3):153–7.

    Article  PubMed  Google Scholar 

  35. Schu S, Slotty PJ, Bara G, von Knop M, Edgar D, Vesper J. A prospective, randomised, double-blind, placebo-controlled study to examine the effectiveness of burst spinal cord stimulation patterns for the treatment of failed back surgery syndrome. Neuromodulation. 2014;17(5):443–50.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Neurosurgery, Parkway Neuroscience and Spine Institute, 17 Western Maryland Parkway, Hagerstown, MD, 21795, USA

    Peter G. Campbell M.D.

  2. Neurosurgery, St. Luke’s University Health Network, 701 Ostrum St, Suite 302, Bethlehem, PA, 18017, USA

    Steven M. Falowski M.D.

Authors
  1. Peter G. Campbell M.D.
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  2. Steven M. Falowski M.D.
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Corresponding author

Correspondence to Peter G. Campbell M.D. .

Editor information

Editors and Affiliations

  1. St. Luke’s University Health Network, Neurosurgery, Bethlehem, Pennsylvania, USA

    Steven M. Falowski

  2. Summit Pain Alliance, Santa Rosa, California, USA

    Jason E. Pope

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© 2016 Springer International Publishing Switzerland

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Campbell, P.G., Falowski, S.M. (2016). Epidural Paddle Placement for Spinal Cord Stimulation. In: Falowski, S., Pope, J. (eds) Integrating Pain Treatment into Your Spine Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-27796-7_15

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  • DOI: https://doi.org/10.1007/978-3-319-27796-7_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27794-3

  • Online ISBN: 978-3-319-27796-7

  • eBook Packages: MedicineMedicine (R0)

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