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Published on: June 26, 2018
Accidental subdural spinal cord stimulator lead placement and stimulation
Jason E Pope1, Michael Stanton-Hicks
1Division of Anesthesiology, Department of Pain Management, Cleveland Clinic, Cleveland, OH 44195, USA. popeje@me.com
Summary
Spinal cord stimulation (SCS) may lead to subdural lead placement, a complication potentially occurring more often than recognized. This case report details subdural SCS lead placement and stimulation parameters, aiming to improve procedural safety.
Area of Science:
- Neurosurgery
- Pain Management
- Neuromodulation
Background:
- Spinal cord stimulation (SCS) is a common treatment for neuropathic pain.
- Increasing use of SCS leads to a rise in procedural complications.
- Limited literature exists on SCS lead placement within the subdural space.
Observation:
- A case report details percutaneous SCS lead placement.
- Stimulation characteristics suggested extra-epidural lead placement.
- Subdural placement was suspected due to lack of cerebrospinal fluid and absence of post-dural puncture headache.
Findings:
- Subdural lead placement was identified.
- Stimulation parameters included a frequency of 40 Hz and pulse width of 650 microseconds.
- A significant discrepancy in current (3.2 mA vs. 0.9 mA) was noted between leads, with intense stimulation reported on one side.
Implications:
- Subdural SCS lead placement may be an underrecognized complication.
- Understanding subdural placement can help reduce procedural risks.
- Further research is needed to refine SCS techniques and minimize morbidity.
