Images in Practice: Replacement of an 18-Year-Old Spinal Cord Stimulator Paddle Lead with Cylindrical Leads Under Direct
- PDF / 2,229,227 Bytes
- 5 Pages / 595.276 x 790.866 pts Page_size
- 101 Downloads / 194 Views
IMAGES IN PRACTICE
Images in Practice: Replacement of an 18-Year-Old Spinal Cord Stimulator Paddle Lead with Cylindrical Leads Under Direct Visualization Philip M. Shumsky . Christopher S. Wie . John A. Freeman . Omar Viswanath . Naresh P. Patel
Received: May 27, 2020 Ó The Author(s) 2020
Keywords: Cylindrical lead; Neuromodulation; Neurosurgery; Spinal cord stimulation (SCS); Paddle lead; Pain; Medicine
CASE Traditionally, spinal cord neuromodulation included paddle lead placement; however, recent technological innovations have led to less invasive techniques [1, 2]. There is debate on how to proceed with treatment in patients with previous paddle lead spinal cord stimulation (SCS) who are no longer reporting adequate pain relief, thought to be due to extensive scar tissue that can form over the paddle [3, 4].
Key Summary Points Background The origins of spinal cord neuromodulation for pain were centered around paddle lead placement requiring extensive surgery and, more often than not, permanent lead placement even after treatment sensitization. Recently, percutaneous cylindrical lead placement has fallen in favor because of the less invasive implantation, flexibility of lead placement, and improved innovative technology Aims
Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12472628. P. M. Shumsky (&) C. S. Wie J. A. Freeman Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA e-mail: [email protected] N. P. Patel Department of Neurologic Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA O. Viswanath Valley Anesthesiology and Pain ConsultantsEnvision Physician Services, Phoenix, AZ, USA O. Viswanath Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
The aim of this case is to demonstrate the technique used to remove a previous paddle lead implant and replace it with percutaneous cylindrical leads under direct visualization Key Findings A technical example of successful longterm paddle lead removal with replacement by percutaneous cylindrical leads resulting in improved pain control and decreased opioid use
Pain Ther
Typically, if a paddle lead is no longer effective, a revision surgery is performed to place a new paddle, which may increase the risks of abandonment technology and perioperative complications, increased treatment costs, and potential worsening of the patient’s overall pain level [4–6]. This case describes a 58-year-old woman with a history multiple lower back surgeries who was originally implanted with an 8-electrode (4 9 2) paddle lead via a T11 laminectomy spanning the T10–T11 vertebrae. Years later, the patient presented with worsened pain and loss of therapy, with subsequent decision to remove the original paddle lead and place cylindrical leads compatible with her current generator system. Fluoroscopy was utilized to identify the paddle lead, which was removed intact without complication with careful posterior surgical dissection. Two separate 8-cont
Data Loading...
