Presented at the 2013 AAPM Annual Meeting « Back

Advanced Spinal Cord Stimulator Lead Anchoring and Multiple Lead Placement Technique Through an Individual Port: A Case Series

Daniel A. Fung, MD, dfungmd@gmail.com¹, Timothy Davis, MD¹, (1) The Center for Spinal and Joint Restoration, Santa Monica, California

Introduction: To introduce a novel and advanced lead anchoring technique as well as introduce the emerging technology of large single port introducers and percutaneous paddle leads. Case Description/Methods: Each of the three cases had implantation of spinal cord stimulator due to various reasons. A large single port introducer (Epiducer) was used to place various arrays of lead combinations including slim paddle electrodes and wire electrodes to the target areas. Dissection along the spinous process was performed and a perforating towel clamp was used to create an anchoring point in the spinous process for the electrodes. Anchors were placed along the spinous process deep in the paraspinal musculature. Assessment/Results: The three patients had successful implantation with no immediate complications. Stimulation covered their location of pain and reduced their pain complaints. On follow-up, patients continued to achieve ideal stimulation and did not have any significant complications, with no evidence of lead migration or implant discomfort. Conclusions: With the right patient selection and screening process, spinal cord stimulation can be an effective, relatively safe and reversible treatment for management of certain pain conditions. Using a combination of our proposed advanced anchoring technique and large single port introducers we hope to address and decrease the incidence of two of the most common complications of SCS systems, lead migration and anchor site pain. In addition, we introduce large single port introducers which have revolutionized the field by allowing multiple lead arrays and paddle leads to be placed through a single percutaneous port. References: 1) Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965; 150:971-979. 2) Shealy S, Mortimer JT, Reswick JB. Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesthesia and Analgesia 1967; 46(4):489-491. 3) Cameron T. Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: a 20-year literature review. J Neurosurg: Spine 2004; 100:254-267. 4) de Jongste MJL, Nagelkerke D, Hooyschuur CM, et al. Stimulation characteristics, complications and efficacy of spinal cord stimulation systems in patients with refractory angina: a prospectice feasibility study. PACE 1994; 17:1751-1760. 5) Hegarty D. Spinal cord stimulation: The clinical application of new technology. Anesthesiology Research and Practice 2011; 2012:1-5. 6) Turner JA, Loeser JD, Deyo RA, Sanders SB. Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome: a systematic review of effectiveness and complications. Pain 2004; 108:137-147. 7) Kemler MA, Gerard AM, van Kleef M, et al. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. The New England Journal of Medicine 2000. 343(9):618-623. 8) Kumar K, Taylor RS, Jacques, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: A multicentre randomized controlled trial in patients with failed back surgery syndrome. Pain 2007; 132:179-188. 9) North RB, Kidd DH, Farrokhi F, Piantadosi SA. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: A randomized controlled trial. Neurosurgery 2005. 56(1):98-106. 10) Burchiel KJ, Anderson VC, Brown FD, et al. Prospective multicenter study of spinal cord stimulation for relief of chronic back and extremity pain. Spine 1996; 21(23):2786-2794.

Funding: None