Percutaneous implanted paddle lead for spinal cord stimulation: technical considerations and long-term follow-up.
OBJECTIVE
Spinal cord stimulation (SCS) is an established method for treatment of chronic pain. Cylindrical-type leads can be implanted percutaneously. In contrast, paddle leads (lamitrode) require more invasive surgery (i.e., laminotomy or laminectomy) for placement into the epidural space, thereby offering several advantages over percutaneous leads (octrode), including less lead migration and better paresthesia coverage. The goal of this study was to prospectively demonstrate the safety and efficacy of a percutaneous paddle lead for SCS.


METHODS
This prospective trial enrolled 81 patients. The mean age was 57 years (range 27-82 years) with an almost equal sex distribution (male 47%, female 53%). Most patients (90%) had failed back surgery syndrome combined with lower extremity pain and lower back pain. A percutaneous paddle lead was implanted using a novel introduction system for percutaneous implantation. All implantations were performed under local anesthesia. Prior to the final implantation of the impulse generator, all patients underwent seven days of trial stimulation with pain assessment using a visual analog scale (VAS). The median follow-up was 12 months.


RESULTS
The data showed favorable clinical outcomes for paresthesia coverage and pain reduction (median VAS 8.4 vs. 2.3), with a risk profile comparable with known percutaneous techniques. Compared with the published data (2-22%), the lead migration rate in this study was low (2.5%). No perioperative complications occurred.


CONCLUSIONS
This new, minimally invasive percutaneous paddle lead is effective and safe, with a low migration rate. Placement can be done under local anesthesia, allowing an intraoperative assessment of the paresthesia coverage in terms of pain relief. This approach is less invasive and offers a faster and more comfortable procedure compared with laminotomy or laminectomy.
Centre of Neuromodulation, Department of Neurosurgery, Heinrich-Heine University Hospital, Düsseldorf, Germany. thomas.kinfe@med.uni-duesseldorf.de
Thomas M
TM
Kinfe
Stefan
S
Schu
Florian J
FJ
Quack
Christian
C
Wille
Jan
J
Vesper
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D004567:Electrodes, Implanted / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010292:Paresthesia / Q000209:etiology / Q000628:therapy; D016684:Prone Position; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D013116:Spinal Cord / Q000502:physiology*; D004561:Transcutaneous Electric Nerve Stimulation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome