OBJECTIVES: To illustrate a new surgical revision strategy for malfunctioning spinal cord stimulation (SCS) paddle electrodes. BACKGROUND: SCS is a treatment for chronic neuropathic pain that delivers therapeutic doses of electric current to the dorsal columns resulting in dermatomal paresthesia and pain reduction. Reasons for SCS failure include hardware malfunction or breakage and medical complications. CASE REPORT: A 34-year-old woman presented with a two-year history of intractable pain in the left upper extremity and thoracic region which was previously controlled by SCS. Imaging demonstrated breakage of the cervical electrode wire that had been advanced in the caudal direction from the C1 spinal level. Revision of the broken electrode was performed by hemilaminectomy of C3-C4 and the replacement electrode was advanced in the cephalad direction. RESULTS: Ideal and exact paresthesia pattern was confirmed intraoperatively and the patient maintained successful pain reduction at five-year follow-up. CONCLUSION: Advancing SCS electrodes into the upper cervical spine in the cephalad direction, using the previously formed scar capsule, offers an alternate strategy for revision of malfunctioning SCS paddle electrodes.
OBJECTIVES: To illustrate a new surgical revision strategy for malfunctioning spinal cord stimulation (SCS) paddle electrodes. BACKGROUND: SCS is a treatment for chronic neuropathic pain that delivers therapeutic doses of electric current to the dorsal columns resulting in dermatomal paresthesia and pain reduction. Reasons for SCS failure include hardware malfunction or breakage and medical complications. CASE REPORT: A 34-year-old woman presented with a two-year history of intractable pain in the left upper extremity and thoracic region which was previously controlled by SCS. Imaging demonstrated breakage of the cervical electrode wire that had been advanced in the caudal direction from the C1 spinal level. Revision of the broken electrode was performed by hemilaminectomy of C3-C4 and the replacement electrode was advanced in the cephalad direction. RESULTS: Ideal and exact paresthesia pattern was confirmed intraoperatively and the patient maintained successful pain reduction at five-year follow-up. CONCLUSION: Advancing SCS electrodes into the upper cervical spine in the cephalad direction, using the previously formed scar capsule, offers an alternate strategy for revision of malfunctioning SCS paddle electrodes.
Authors: Abram Burgher; Peter Kosek; Steven Surrett; Steven M Rosen; Todd Bromberg; Ashish Gulve; Anu Kansal; Paul Wu; W Porter McRoberts; Ashish Udeshi; Michael Esposito; Bradford E Gliner; Mona Maneshi; Anand Rotte; Jeyakumar Subbaroyan Journal: J Pain Res Date: 2020-11-10 Impact factor: 3.133