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Dural Puncture During Spinal Cord Stimulator Lead Insertion: Analysis of Practice Patterns.

Warren A Southerland1, Jamal Hasoon1,2,3, Ivan Urits1,4

  • 1Department of Anesthesia, Beth Israel Deaconess Medical Center, Critical Care, and Pain Medicine; Harvard Medical School, Boston, MA, USA.

Anesthesiology and Pain Medicine
|September 26, 2022
PubMed
Summary

Managing dural punctures during spinal cord stimulation (SCS) procedures involves continuing at a different level, though abandoning the trial is also common. Physician choices for SCS lead insertion complications show varied but consistent patterns.

Keywords:
Chronic PainDural PunctureNeuromodulationPatient SafetyPostdural Puncture HeadacheSpinal Cord Stimulation

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Area of Science:

  • Pain Management
  • Neurosurgery
  • Interventional Pain Medicine

Background:

  • Spinal cord stimulation (SCS) is a key treatment for intractable pain.
  • Percutaneous SCS lead insertion requires safe epidural space access.
  • Dural puncture is a potential complication during SCS lead placement.

Purpose of the Study:

  • To analyze practice patterns for managing dural punctures during SCS trials and implantations.
  • To understand physician decision-making following inadvertent dural puncture.

Main Methods:

  • A survey was administered to members of the Spine Intervention Society and American Society of Regional Anesthesia.
  • The survey focused on decision-making in cases of dural puncture during SCS lead insertion.
  • Responses were collected regarding management during SCS trials and permanent implantations.

Main Results:

  • A majority of physicians (56.99% for trials, 61.67% for implants) chose to continue the procedure at a different level after dural puncture.
  • Approximately 27.98% of physicians abandoned SCS trials, and 21.67% abandoned permanent implantations following dural puncture.
  • Decision-making was minimally influenced by whether the dural puncture occurred during a trial or a permanent implantation.

Conclusions:

  • Physician practices for managing dural punctures during SCS procedures are varied, with continuing at a different level being the most common approach.
  • Abandoning the procedure is also a significant choice, indicating no single consensus.
  • These findings reflect contemporary SCS practices and provide insights for managing dural punctures.