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Retrograde thoracic spinal cord stimulation paddle placement for complex persistent spinal pain syndrome type 2.

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Title: Retrograde thoracic spinal cord stimulation paddle placement for complex persistent spinal pain syndrome type 2.
Authors: de Monaco, Bernardo Assumpcao, Piedade, Guilherme Santos, Doomi, Ahmed, Jagid, Jonathan R., Almeida, Timoteo, Cordeiro, Joacir Graciolli
Source: Pain Practice. Mar2024, Vol. 24 Issue 3, p483-488. 6p.
Subjects: Electrotherapeutics, Patient safety, Artificial implants, Minimally invasive procedures, Descriptive statistics, Case studies, Backache, Spine diseases, Electrodes
Abstract: Background: Spinal cord stimulation (SCS) is a cost‐effective option for treating refractory persistent spinal pain syndrome type‐2 (PSPS‐2). For patients with extensive spine instrumentation including the thoraco‐lumbar junction, percutaneous placement of SCS leads is usually not an option being paddle leads typically implanted anterograde. Paddle lead placement will be particularly challenging in more complex cases when the instrumentation covers the targeted level. To overcome this barrier, we studied using a retrograde approach to reach the sweet spot, facilitate the placement, and reduce associated risks. Objectives: To study the use of retrograde SCS paddle as a placement method to optimize the spinal cord target and reduce the risks of conventional placement in complex cases. Study Design: Case series and technical note. Methods: We present three cases of thoracic retrograde SCS paddle lead placement cases, detailing patient selection, operative technique, and outcome. All the cases had extensive instrumentation to the thoraco‐lumbar spine, and one had additional spinal canal stenosis. The surgical procedure entailed a retrograde midthoracic inter‐laminar approach, flavectomy, and caudal placement of the paddle lead with intraoperative neurophysiologic monitoring (IONM) guidance for functional midline determination. Results: All the cases had a successful lead placement over the sweet spot without complications. The same approach was used to decompress a focal spinal stenosis in one case. One case had significantly improved pain and hence underwent a pulse generator implant. The other cases had non‐satisfactory pain control and were explanted. Limitations: These case description could guide technical procedural steps, however, a larger number of such cases would be needed to describe further technical nuances. Conclusions: We demonstrated that placing SCS paddle leads via retrograde midthoracic approach with IONM guidance is safe. This procedure should be an option for SCS paddle implants in patients with posterior spinal fusion encompassing the intended targeted spinal stimulation level. [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: Retrograde thoracic spinal cord stimulation paddle placement for complex persistent spinal pain syndrome type 2.
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  Data: <searchLink fieldCode="AR" term="%22de+Monaco%2C+Bernardo+Assumpcao%22">de Monaco, Bernardo Assumpcao</searchLink><br /><searchLink fieldCode="AR" term="%22Piedade%2C+Guilherme+Santos%22">Piedade, Guilherme Santos</searchLink><br /><searchLink fieldCode="AR" term="%22Doomi%2C+Ahmed%22">Doomi, Ahmed</searchLink><br /><searchLink fieldCode="AR" term="%22Jagid%2C+Jonathan+R%2E%22">Jagid, Jonathan R.</searchLink><br /><searchLink fieldCode="AR" term="%22Almeida%2C+Timoteo%22">Almeida, Timoteo</searchLink><br /><searchLink fieldCode="AR" term="%22Cordeiro%2C+Joacir+Graciolli%22">Cordeiro, Joacir Graciolli</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Pain+Practice%22">Pain Practice</searchLink>. Mar2024, Vol. 24 Issue 3, p483-488. 6p.
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  Data: <searchLink fieldCode="DE" term="%22Electrotherapeutics%22">Electrotherapeutics</searchLink><br /><searchLink fieldCode="DE" term="%22Patient+safety%22">Patient safety</searchLink><br /><searchLink fieldCode="DE" term="%22Artificial+implants%22">Artificial implants</searchLink><br /><searchLink fieldCode="DE" term="%22Minimally+invasive+procedures%22">Minimally invasive procedures</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Case+studies%22">Case studies</searchLink><br /><searchLink fieldCode="DE" term="%22Backache%22">Backache</searchLink><br /><searchLink fieldCode="DE" term="%22Spine+diseases%22">Spine diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Electrodes%22">Electrodes</searchLink>
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  Data: Background: Spinal cord stimulation (SCS) is a cost‐effective option for treating refractory persistent spinal pain syndrome type‐2 (PSPS‐2). For patients with extensive spine instrumentation including the thoraco‐lumbar junction, percutaneous placement of SCS leads is usually not an option being paddle leads typically implanted anterograde. Paddle lead placement will be particularly challenging in more complex cases when the instrumentation covers the targeted level. To overcome this barrier, we studied using a retrograde approach to reach the sweet spot, facilitate the placement, and reduce associated risks. Objectives: To study the use of retrograde SCS paddle as a placement method to optimize the spinal cord target and reduce the risks of conventional placement in complex cases. Study Design: Case series and technical note. Methods: We present three cases of thoracic retrograde SCS paddle lead placement cases, detailing patient selection, operative technique, and outcome. All the cases had extensive instrumentation to the thoraco‐lumbar spine, and one had additional spinal canal stenosis. The surgical procedure entailed a retrograde midthoracic inter‐laminar approach, flavectomy, and caudal placement of the paddle lead with intraoperative neurophysiologic monitoring (IONM) guidance for functional midline determination. Results: All the cases had a successful lead placement over the sweet spot without complications. The same approach was used to decompress a focal spinal stenosis in one case. One case had significantly improved pain and hence underwent a pulse generator implant. The other cases had non‐satisfactory pain control and were explanted. Limitations: These case description could guide technical procedural steps, however, a larger number of such cases would be needed to describe further technical nuances. Conclusions: We demonstrated that placing SCS paddle leads via retrograde midthoracic approach with IONM guidance is safe. This procedure should be an option for SCS paddle implants in patients with posterior spinal fusion encompassing the intended targeted spinal stimulation level. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
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  Data: <i>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.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1111/papr.13322
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      – SubjectFull: Artificial implants
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      – SubjectFull: Minimally invasive procedures
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      – SubjectFull: Electrodes
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      – TitleFull: Retrograde thoracic spinal cord stimulation paddle placement for complex persistent spinal pain syndrome type 2.
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              Text: Mar2024
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