title: The use of intraoperative electrophysiology for the placement of spinal cord stimulator paddle leads under general anesthesia.
abstract: BACKGROUND
  Placement of spinal cord stimulating paddle leads has traditionally been performed under local anesthesia with intravenous sedation to allow intraoperative confirmation of appropriate placement. It may be difficult to maintain appropriate sedation in certain patients because of medical comorbidities. Furthermore, patients undergoing lead revision frequently have extensive epidural scarring, requiring multilevel laminectomies to place the electrode appropriately.
  
  
  OBJECTIVE
  To report our technique of neurophysiologic monitoring that allows these procedures to be performed under general anesthesia.
  
  
  METHODS
  Data from 78 patients who underwent electromyography during laminectomy for paddle lead placement were retrospectively reviewed. Seventy patients presented for first-time permanent system placement after a successful trial, and 8 were referred for revision or replacement of previously functioning systems. Surgeries were performed under general anesthesia with fluoroscopic guidance. Electromyography was used to help define the physiological midline of the spinal cord and to guide appropriate lead placement. Somatosensory evoked potentials were used as an adjunct to minimize the possibility of neural injury.
  
  
  RESULTS
  Immediately postoperatively, 75 of 78 patients reported that the paresthesia coverage was as good as (or better than) that of the spinal cord stimulation trial. At the long-term follow-up, 1 system was removed for infection, and 6 systems were explanted for lack of efficacy. A total of 64 of the 78 implanted patients reported continued pain relief with stimulator use. Revision surgery was performed in 9 patients.
  
  
  CONCLUSIONS
  The use of intraoperative electrophysiology for the placement of spinal cord stimulation paddle leads under general anesthesia is a safe and efficacious alternative to awake surgery.
authors.affiliation: Department of Neurosurgery, Harvey Cushing Institute of Neurosciences, Hofstra University School of Medicine and North Shore University Hospital, Manhasset, New York, USA.
authors.forename: Antonios
authors.initials: A
authors.lastname: Mammis
authors.forename: Alon Y
authors.initials: AY
authors.lastname: Mogilner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004599:Electric Stimulation Therapy / Q000295:instrumentation* / Q000379:methods*; D004566:Electrodes / Q000592:standards; D004576:Electromyography / Q000379:methods; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D012189:Retrospective Studies; D013116:Spinal Cord / Q000601:surgery*; D055815:Young Adult