title: Cranial plate anchoring of spinal cord stimulation paddle leads:  technical note.
abstract: BACKGROUND
  Lead migration is a frequent complication of spinal cord stimulation (SCS) and requires revision surgery. The evolution of wider paddle leads has necessitated more extensive laminotomy and epidural adhesiolysis, which may increase the risk of lead migration.
  
  
  OBJECTIVE
  We describe a novel anchoring technique for SCS paddle leads with use of a cranial "dogbone" plate.
  
  
  METHODS
  We retrospectively reviewed a consecutive series of 11 patients who underwent placement of paddle lead spinal cord stimulators with titanium plate anchoring. Patients were followed for a mean of 29.5 months from SCS implantation (range, 5-65 months). A 4-hole linear titanium cranial plate and two 4-mm screws were used to tightly affix the proximal paddle lead wiring to the lamina below the laminotomy defect.
  
  
  RESULTS
  All patients continue to have satisfactory spinal cord stimulation with no loss of efficacy or need for revision. No complications have been attributed to titanium plate anchoring, and there have been no cases of lead migration with this technique. Titanium plate anchoring added minimal time (approximately 3-5 minutes) to the operative case.
  
  
  CONCLUSIONS
  We report a safe and effective anchoring technique for paddle lead SCS with the use of a cranial plate. Our experience has been that this technique, which anchors the proximal lead wiring to the remaining lamina at the inferior laminotomy defect, is superior to anchoring methods that rely on suturing of lead wiring.
authors.affiliation: Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA. ntomycz@wpahs.org
authors.forename: Nestor D
authors.initials: ND
authors.lastname: Tomycz
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cameron
authors.forename: Donald M
authors.initials: DM
authors.lastname: Whiting
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Oh
mesh_terms: D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D006801:Humans; D016268:Internal Fixators; D012886:Skull / Q000601:surgery*; D013116:Spinal Cord / Q000601:surgery*