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Published on: June 26, 2018
Prevention of mechanical failures in implanted spinal cord stimulation systems
Jaimie M Henderson1, C M Schade, John Sasaki
1Stereotactic and Functional Neurosurgery, Stanford University School of Medicine, Stanford, Calif; 2692 W. Walnut, Suite 105, Garland, Tex 75042; Casa Colina Hospital, PO Box 6001, Pomona, Calif; St. Mary's Pain Relief Center, Huntington, WVa; and Yellowstone Neurosurgery Associates, PC, Billings, Mont, USA.
Improving spinal cord stimulation (SCS) longevity involves optimizing surgical techniques. Best practices, like using soft anchors and specific lead placements, significantly reduce mechanical failures and enhance system reliability for neuropathic pain treatment.
Area of Science:
- Neurosurgery
- Biomedical Engineering
- Pain Management
Background:
- Spinal cord stimulation (SCS) effectively treats neuropathic extremity pain, with success rates up to 70%.
- Mechanical failures, such as lead breakage and migration, compromise long-term SCS efficacy.
- Systematic analysis of surgical techniques and biomechanical testing are crucial for improving SCS device longevity.
Purpose of the Study:
- To systematically analyze surgical techniques for spinal cord stimulation (SCS) systems.
- To conduct in vivo and in vitro biomechanical testing of SCS system components.
- To identify factors influencing the long-term reliability and mechanical integrity of SCS devices.
Main Methods:
- Computer modeling based on morphometric data to predict SCS system component movement and forces.
- Laboratory testing of leads and anchors under repetitive stress to determine failure points.
- In vivo biomechanical analysis using a sheep model to assess system compliances and failure thresholds.
Main Results:
- A soft silastic anchor, when pushed through fascia to increase lead bend radius, extended time to failure by 65 times compared to unsupported leads.
- Surgical paddle leads failed when used with an anchor, but showed no failures up to 1 million cycles without an anchor.
- Panel recommendations included a paramedian approach, abdominal pulse generator placement, and maximizing bend radius via fascia-anchoring techniques.
Conclusions:
- Technical factors significantly impact the reliability and longevity of spinal cord stimulation systems.
- Implementing specific surgical 'best practices' is essential for maintaining SCS system integrity over time.
- Optimized surgical techniques can substantially reduce mechanical failures and improve long-term SCS effectiveness.
