title: Midline minimally invasive placement of spinal cord stimulators: a technical note.
abstract: BACKGROUND
  Spinal cord stimulators (SCSs) have conventionally been implanted through open approaches requiring extensive muscle dissection to perform laminectomies and permanently place the paddle lead. This approach could contribute to worsening the pain syndrome in patients who experience chronic pain. In an attempt to reduce operative times, minimize blood loss and postoperative pain, and ease the technical challenges of placing the paddle lead in the midline via a paramedian and off-midline incision, we designed a new minimally invasive surgery (MIS) technique to place the paddle lead using a tubular retractor system through a true midline approach.
  
  
  METHODS
  We performed a retrospective review of all MIS paddle lead placements performed by the senior author between October 2010 and June 2013. Patient demographics; clinical indications for placement of paddle lead; location of paddle lead; and perioperative data including blood loss, length of surgery, and surgical and perioperative morbidity were recorded.
  
  
  RESULTS
  Between October 2010 and June 2013, 78 patients had MIS placement of paddle lead SCSs. Patient ages ranged from 27 to 87 years old, with a mean age of 59. The most common levels for paddle lead placement were T8 and T9. No minor or major neurologic complications occurred in our patient population. No patient was readmitted after being discharged from the hospital and all surgeries were outpatient procedures. We had a migration rate comparable to open techniques and minimal blood loss.
  
  
  CONCLUSIONS
  Our technique is safe and effective and carries minimal surgical morbidity compared to standard open techniques for placement of SCSs.
authors.affiliation: Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Edison P
authors.initials: EP
authors.lastname: Valle-Giler
authors.affiliation: Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Wale A R
authors.initials: WA
authors.lastname: Sulaiman
keywords: Back pain; electric stimulation therapy; spinal cord; spinal cord stimulation; surgical procedures–minimally invasive