title: Incidence and avoidance of neurologic complications with paddle type spinal cord stimulation leads.
abstract: BACKGROUND
  While reference is frequently made to the risk of spinal cord or nerve root injury with the surgical implantation of paddle type spinal cord stimulation (SCS) electrodes, data are lacking on the frequency, causes, and prevention of these complications.
  
  
  METHODS
  To determine the incidence and frequency of neurologic complications, we performed 1) a comprehensive analysis of the literature to determine the incidence of complications that have caused or could lead to neurologic injury; 2) an analysis of the US Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) data base; and 3) an investigation of manufacturers' data on surgically implanted paddle electrodes. We then convened an expert panel of neurosurgeons experienced in the surgical implantation of paddle electrodes to provide recommendations to minimize the risk of neurologic injury.
  
  
  RESULTS
  The scientific literature describes the breadth of neurologic complications that can result from SCS electrode implantation but does not provide interpretable data with respect to the incidence and frequency of these complications. The MAUDE data base is not constructed to be sensitive or specific enough to provide these critical data. Primary data show a risk of neurologic injury from implantation of paddle electrodes below 0.6%.
  
  
  CONCLUSIONS
  Preoperative, intraoperative, and postoperative measures to further minimize this risk are described.
  
  
  CONCLUSIONS
  This investigation, the first comprehensive evaluation of the incidence and frequency of neurologic injury as a result of SCS paddle electrode implantation, suggests that neurologic injury is a rare, but serious, complication of SCS. The incidence of these complications should be decreased by the adoption of approaches that improve procedural safety and by careful patient follow-up and complication management. Physicians should be aware of these approaches and take every precaution to reduce the risk of neurologic injury. Physicians also should report any adverse event leading to injury or death and work together to improve access to these data.
authors.affiliation: Department of Neurological Surgery, University of Florida College of Medicine, Jacksonville, Florida, USA. rml199@northwestern.edu
authors.forename: Robert
authors.initials: R
authors.lastname: Levy
authors.forename: Jaimie
authors.initials: J
authors.lastname: Henderson
authors.forename: Konstantin
authors.initials: K
authors.lastname: Slavin
authors.forename: Brian A
authors.initials: BA
authors.lastname: Simpson
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Barolat
authors.forename: Jane
authors.initials: J
authors.lastname: Shipley
authors.forename: Richard
authors.initials: R
authors.lastname: North
mesh_terms: D016208:Databases, Factual; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000295:instrumentation*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D006801:Humans; D009422:Nervous System Diseases / Q000209:etiology*; D011183:Postoperative Complications; D013116:Spinal Cord / Q000502:physiology*