In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Revision of Non-Functioning Percutaneous Spinal Cord Stimulators Can Be Safely Performed with Mini-Open Placement of Laminectomy Paddle Lead Stimulators Secured with Bone Cement

    Final Number:
    1676

    Authors:
    Justin Marion Haydel; Sudheer Ambekar MBBS, MCh; Rishi Kumar Wadhwa MD; Menarvia K. C. Nixon MD; Jamie Toms; Bharat Guthikonda MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Spinal cord stimulation is a commonly used modality for treatment of medically and surgically refractory low-back and lower extremity pain. Percutaneous or laminectomy paddle leads can be placed. Percutaneous lead placement has a higher rate of lead migration requiring revision. Replacing percutaneous leads with new percutaneous leads can be difficult due to the presence of scar tissue. Our study evaluated the feasibility, efficacy, and complications associated with revising non-functioning percutaneous spinal cord stimulator (SCS) leads with mini-open laminectomy lead placement

    Methods: All patients who underwent revision of non-functioning percutaneous SCS leads with laminectomy lead placement from January, 2009 -September 2012 were included in the study. A prospectively kept database was retrospectively analyzed. Operative summaries, intra-operative and post-operative radiographs, and clinical pain outcomes were reviewed. All percutaneous lead systems were replaced with laminectomy paddle leads placed using a mini-open laminectomy. Conscious sedation and epidural anesthesia were used in all patients to allow intraoperative testing to be performed. Once satisfied with intraoperative pain coverage, the paddle lead was secured using silk suture and bone cement. All cases were reviewed post-operatively for pain control, paddle lead migration, and complications

    Results: 20 patients underwent 20 revision surgeries. All patients underwent successful complete removal of the percutaneous leads and placement of a midline laminectomy paddle lead placement. Mean follow-up time was 12 months (6-24months). >75% back pain relief was achieved in 16 of 20 patients (80%) at latest follow-up. >75 % leg pain relief was achieved in 18 of 20 patients (90%). No cases of lead migration were seen at 6 months after surgery. No cases of epidural hematoma, CSF leak, neurological decline, or wound infection were seen. No further revisions were necessary in our case series

    Conclusions: These results indicate that a mini-open placement of a laminectomy paddle lead that is secured with suture and bone cement is a safe, effective, and lasting modality of revision of non-functioning percutaneous SCS leads. Direct epidural scar lysis can be safely achieved via this method, thus allowing optimal placement of the laminectomy paddle lead

    Patient Care: this study indicates that a mini-open placement of a laminectomy paddle lead that is secured with suture and bone cement is a safe, effective, and lasting modality of revision of non-functioning percutaneous SCS leads

    Learning Objectives: by the end of this session, participants should be able to appreciate the causes and management options of non-functioning percutaneous spinal cord stimulator leads

    References:

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy