gms | German Medical Science

63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

13. - 16. Juni 2012, Leipzig

Percutaneous lead electrode implantation in the cervical spine for dislocation after successful treatment with cylindrical lead

Meeting Abstract

Suche in Medline nach

  • G. Lepski - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
  • M. Tatagiba - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
  • M. Morgalla - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 030

DOI: 10.3205/12dgnc417, URN: urn:nbn:de:0183-12dgnc4171

Veröffentlicht: 4. Juni 2012

© 2012 Lepski et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Spinal cord stimulation has proved to be an effective treatment option for neuropathic pain. Nevertheless, targeting the upper extremities is still troublesome, since most available cylindrical electrodes very often dislocate due to the high mobility of the cervical spine. On the other side, plate electrodes cannot be implanted in local anesthesia, what allows for intraoperative testing. Herein, we report our experience with 4 patients submitted to percutaneous implantation of paddle leads in the cervical spine. Surgical technique, functional results and indications are discussed.

Methods: Between June 2010 and June 2011, 4 patients with various clinical conditions (Raynaud Syndrome in the hand, cluster headache, post-traumatic myelopathy, and CRPS) were submitted to percutaneous implantation of paddle leads (model S8, St. Jude Medical) in local anesthesia. Three patients had treatment failure due to dislocation of cylindrical electrodes after a good initial response (3 to 5 reoperations), and one patient was submitted to a first trial stimulation. We evaluated pain intensity and quality of life at 3 and 6 months by the Brief Pain Inventory, Pain Disability Index, and SF36.

Results: After 13±5 months follow-up, three patients had optimal response to stimulation with the paddle lead (before vs. after p<0.001); one patient (post-traumatic myelopathy) reported even stronger pain under stimulation, and was submitted to a DREZ-lesion by the explantation, with good results. Electrode dislocation was not observed. Furthermore, patients reported that stimulation was more stable with the paddle leads, and a broader body area was covered with stimulation-induced paresthesias.

Conclusions: Percutaneous paddle leads represent a good treatment option for patients with neuropathic pain in the upper extremities, and should be considered if patients present dislocation of cylindrical electrodes.