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Analysis of spinal canal diameter in the placement of thoracic spinal cord stimulator paddle leads.

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Title: Analysis of spinal canal diameter in the placement of thoracic spinal cord stimulator paddle leads.
Authors: Ragel, Brian T., Riedman, Tressa, McGehee, Matthew, Raslan, Ahmed M.
Source: Pain Practice. Jan2024, Vol. 24 Issue 1, p91-100. 10p.
Subjects: Spinal canal, Spinal cord, Electrodes, Neurological disorders, Artificial implants, Spinal stenosis, Mann Whitney U Test, Magnetic resonance imaging, Descriptive statistics, Neural stimulation, Thoracic vertebrae, Laminectomy, Paraplegia
Abstract: Background: Neurologic 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. Objective: This imaging study was undertaken to determine the minimum canal diameter required for safe paddle lead placement. Methods: Patients 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. Results: Of 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). Conclusion: Postoperative 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. [ABSTRACT FROM AUTHOR]
Copyright of Pain Practice is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Analysis of spinal canal diameter in the placement of thoracic spinal cord stimulator paddle leads.
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22Pain+Practice%22&quot;&gt;Pain Practice&lt;/searchLink&gt;. Jan2024, Vol. 24 Issue 1, p91-100. 10p.
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– Name: Abstract
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  Data: Background: Neurologic 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. Objective: This imaging study was undertaken to determine the minimum canal diameter required for safe paddle lead placement. Methods: Patients 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. Results: Of 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 &lt;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 &lt; 0.0001). Conclusion: Postoperative 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 &gt;10 mm. If canal diameter is &lt;12 mm, aggressive undercutting of the lamina, a second laminotomy, or placement of smaller SCS wire leads should be considered. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Pain Practice is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
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    Identifiers:
      – Type: doi
        Value: 10.1111/papr.13289
    Languages:
      – Code: eng
        Text: English
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        PageCount: 10
        StartPage: 91
    Subjects:
      – SubjectFull: Spinal canal
        Type: general
      – SubjectFull: Spinal cord
        Type: general
      – SubjectFull: Electrodes
        Type: general
      – SubjectFull: Neurological disorders
        Type: general
      – SubjectFull: Artificial implants
        Type: general
      – SubjectFull: Spinal stenosis
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      – SubjectFull: Mann Whitney U Test
        Type: general
      – SubjectFull: Magnetic resonance imaging
        Type: general
      – SubjectFull: Descriptive statistics
        Type: general
      – SubjectFull: Neural stimulation
        Type: general
      – SubjectFull: Thoracic vertebrae
        Type: general
      – SubjectFull: Laminectomy
        Type: general
      – SubjectFull: Paraplegia
        Type: general
    Titles:
      – TitleFull: Analysis of spinal canal diameter in the placement of thoracic spinal cord stimulator paddle leads.
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            NameFull: Ragel, Brian T.
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            NameFull: Riedman, Tressa
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            NameFull: McGehee, Matthew
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              Text: Jan2024
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              Y: 2024
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              Value: 24
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