title: Pont de dolor: a dual laminotomy technique for placing and securing an electrode in the epidural space and comments about anatomic variation that may complicate spinal cord stimulator electrode placement.
abstract: The objective of this report is to describe a surgical technique used successfully when a flat or paddle type spinal cord stimulator electrode cannot be properly positioned via a single laminotomy. Different and innovative surgical techniques useful in placement of spinal cord stimulators and analgesic infusion pump systems have not been well described. The prevalence of anatomic surgical abnormalities or variations that might present barriers to implantation of these devices is unknown but may be as high as 18% for revisions. A dual laminotomy technique can be useful and successful in positioning a flat spinal cord stimulator electrode that cannot be properly positioned via a single laminotomy approach. We report two patients who have been treated successfully with a dual laminotomy technique.
authors.affiliation: Department of Surgery, Division of Neurosurgery and Department of Anesthesiology, Division of Pain Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Perry A
authors.initials: PA
authors.lastname: Ball
authors.forename: Gilbert J
authors.initials: GJ
authors.lastname: Fanciullo