Minimally Invasive Spinal Cord Stimulator Paddle Electrode Placement: Technique and Complications in a Single Surgeon...

Spinal cord stimulation (SCS) is a widespread tool used to treat chronic pain. There are 2 primary methods for permanent implantation of SCS: electrode lead placement through percutaneous needle or paddle electrodes by open laminotomy. The goal of this report was to use a tubular, minimally invasive method to implant SCS paddles, describe the feasibility and safety of the method, and provide a companion video illustration of the technique.

One-hundred two minimally invasive spinal cord stimulator paddle electrode procedures were performed on 76 men and 26 women. We completed a retrospective review of the placement, replacement, and removal of spinal cord stimulator paddle electrodes in this single-surgeon cohort of patients to assess the procedure's feasibility and any technical issues encountered.

There were 86 primary system placements; 11 paddle electrode replacement procedures for lead fractures, lead migration, or revision of the entire system; and 5 procedures for the complete removal of spinal cord stimulator systems without replacement. There were no neurological deficits or epidural hematomas. There was 1 single infection of the device requiring removal and eventual replacement (0.98%), etiology assessed to be likely secondary to dental abscess, not the SCS procedure itself.

We describe a minimally invasive tubular access mediated method, whereby paddle electrodes can be placed successfully with minimal morbidity. We describe any technical issues, provide an accompanying narrated video of an illustrative case, and describe techniques for dealing with paddle migration including the removal of a paddle lead using tubular access.