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

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.