title: Spinal anesthesia and minimal invasive laminotomy for paddle electrode placement in spinal cord stimulation: technical report and clinical results at long-term followup.
abstract: OBJECTIVE
  We arranged a mini-invasive surgical approach for implantation of paddle electrodes for SCS under spinal anesthesia obtaining the best paddle electrode placement and minimizing patients' discomfort. We describe our technique supported by neurophysiological intraoperative monitoring and clinical results.
  
  
  METHODS
  16 patients, affected by neuropathic pain underwent the implantation of paddle electrodes for spinal cord stimulation in lateral decubitus under spinal anesthesia. The paddle was introduced after flavectomy and each patient confirmed the correct distribution of paresthesias induced by intraoperative test stimulation. VAS and patients' satisfaction rate were recorded during the followup and compared to preoperative values.
  
  
  RESULTS
  No patients reported discomfort during the procedure. In all cases, paresthesias coverage of the total painful region was achieved, allowing the best final electrode positioning. At the last followup (mean 36.7 months), 87.5% of the implanted patients had a good rate of satisfaction with a mean VAS score improvement of 70.5%.
  
  
  CONCLUSIONS
  Spinal cord stimulation under spinal anesthesia allows an optimal positioning of the paddle electrodes without any discomfort for patients or neurosurgeons. The best intraoperative positioning allows a better postoperative control of pain, avoiding the risk of blind placements of the paddle or further surgery for their replacement.
authors.affiliation: Division of Neurosurgery, Department of Neuroscience and Rehabilitation, University Hospital S. Anna, 203, C.so Giovecca, Ferrara, 44100 Ferrara, Italy. srbslv@unife.it
authors.forename: S
authors.initials: S
authors.lastname: Sarubbo
authors.forename: F
authors.initials: F
authors.lastname: Latini
authors.forename: V
authors.initials: V
authors.lastname: Tugnoli
authors.forename: R
authors.initials: R
authors.lastname: Quatrale
authors.forename: E
authors.initials: E
authors.lastname: Granieri
authors.forename: M A
authors.initials: MA
authors.lastname: Cavallo
mesh_terms: D000328:Adult; D000368:Aged; D000775:Anesthesia, Spinal / Q000379:methods*; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D055111:Failed Back Surgery Syndrome / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010147:Pain Measurement; D010292:Paresthesia / Q000473:pathology / Q000601:surgery; D013116:Spinal Cord / Q000473:pathology / Q000601:surgery; D013122:Spinal Diseases / Q000473:pathology / Q000601:surgery*