gms | German Medical Science

Objective: Spinal cord stimulation (SCS) is an established method for the treatment of chronic pain. Cylindrical type leads can be implanted percutaneously, most paddle type leads (lamitrodes) require more invasive surgery. Yet paddle type leads offer several advantages, including less lead migration and better paraesthesia coverage. The study demonstrates the stable long-term results of minimal invasive percutaneous implantation and improvement of a paddle lead for Spinal Cord Stimulation.

Methods: Data was collected prospectively. The patients were implanted with paddle lead using an epiducer system for percutaneous implantation. All implantations were done under local anesthesia. Prior to the final implantation of the implantable pulse generator (Eon mini^TM, St. Jude Medical Neuromodulation Division, Plano, TX), all patients underwent seven days of trial stimulation. Median follow-up was 12 months.

Results: 200 patients have been implanted so far. All suffered from failed back surgery syndromes with a combined leg and lower back pain. The data shows excellent clinical outcome for paraesthesia overlap and pain reduction in the legs and the back with a risk profile comparable to known percutaneous techniques (median VAS reduction 8 to 3). They were no major complications. Compared to the literature (up to 30%), the rate of lead migration was low (n = 6–3%).

Conclusions: Our data shows this meanwhile well-approved approach to be effective and safe. Placement is done under local anaesthesia, which allows an intraoperative paraesthesia testing for optimal clinical outcome. The approach offers a faster and more comfortable procedure.