Peter A Pahapill1. 1. Naseff Specialty Center, United Neurosurgery Associates, St. Paul, MN, USA.
Abstract
OBJECTIVES: Spinal cord stimulation (SCS) has become an evidence-based treatment for a variety of chronic pain disorders. A key step in appropriate patient selection and long-term outcome predictability is a percutaneous screening trial of stimulation. Occasionally, a trial cannot be adequately completed with a percutaneous electrode. Rather than depriving this therapy from these patients, the authors have developed a program providing surgically implanted paddle-lead screening trials of SCS. METHODS: Data from 22 patients undergoing paddle-lead screening trials of SCS from October 2009 to August 2012 were retrospectively reviewed. The surgical paddle leads were positioned with thoracic or cervical laminotomies under local anesthetic and conscious sedation, allowing awakened patients to confirm optimal lead placement. Externalized lead extensions were connected to an external pulse generator for a five-day screening trial. Pain reduction of at least 50% was required for patients to have the previously implanted paddle lead connected to an internalized pulse generator; otherwise, the trial surgical paddle leads were removed. RESULTS: Twenty-two patients received five-day paddle-lead stimulation screening trials for various chronic neuropathic pain conditions. All paddle screening trials were well tolerated and completed as outpatient procedures. Sixteen patients received fully implanted systems. At an average follow-up of 23 months, all implanted patients continue to have satisfactory pain control. There were no infections, lead migrations, or revisions. CONCLUSIONS: Surgically implanted paddle-lead screening trials of SCS can be used safely and effectively in those patients in which an adequate percutaneous-electrode trial cannot be completed. Results are similar to those seen with standard percutaneous screening trials. A systematic approach to surgical-paddle screening trials of SCS has not been previously reported.
OBJECTIVES: Spinal cord stimulation (SCS) has become an evidence-based treatment for a variety of chronic pain disorders. A key step in appropriate patient selection and long-term outcome predictability is a percutaneous screening trial of stimulation. Occasionally, a trial cannot be adequately completed with a percutaneous electrode. Rather than depriving this therapy from these patients, the authors have developed a program providing surgically implanted paddle-lead screening trials of SCS. METHODS: Data from 22 patients undergoing paddle-lead screening trials of SCS from October 2009 to August 2012 were retrospectively reviewed. The surgical paddle leads were positioned with thoracic or cervical laminotomies under local anesthetic and conscious sedation, allowing awakened patients to confirm optimal lead placement. Externalized lead extensions were connected to an external pulse generator for a five-day screening trial. Pain reduction of at least 50% was required for patients to have the previously implanted paddle lead connected to an internalized pulse generator; otherwise, the trial surgical paddle leads were removed. RESULTS: Twenty-two patients received five-day paddle-lead stimulation screening trials for various chronic neuropathic pain conditions. All paddle screening trials were well tolerated and completed as outpatient procedures. Sixteen patients received fully implanted systems. At an average follow-up of 23 months, all implanted patients continue to have satisfactory pain control. There were no infections, lead migrations, or revisions. CONCLUSIONS: Surgically implanted paddle-lead screening trials of SCS can be used safely and effectively in those patients in which an adequate percutaneous-electrode trial cannot be completed. Results are similar to those seen with standard percutaneous screening trials. A systematic approach to surgical-paddle screening trials of SCS has not been previously reported.