gms | German Medical Science

Objective: Spinal cord stimulation (SCS) is an established method for treatment of chronic pain. Cylindrical type leads are implanted percutaneously. Paddle type leads require a much more invasive surgery, necessitating laminotomy or laminectomy for lead placement. Paddle type leads offer several advantages over cylindrical type leads, including less lead migration and better paraesthesia coverage. The presented technique combines advantages of both approaches. Demonstrate that the percutaneous introduction of slimline paddle leads is safe and effective. Demonstrate that paddle type leads offer several advantages over cylindrical type leads, including less lead migration and better paraesthesia coverage. Demonstrate that revisions and/or explantations of slimline paddle leads is easy to do

Method: Data was collected prospectively from November 2009–November 2012 all patients suffered from a neuropathic pain syndrome and failed conservative treatment. 214 patients were implanted with a single S-8 slim line paddle lead using the Epiducer^TM lead delivery system for percutaneous implantation. All lead implantations have been done under local anesthesia and underwent at least seven days of trial stimulation. After a successful trial, (minimum pain reduction of 50%) followed the implantation of the implantable pulse generator (Eon mini™, St. Jude Medical) Median follow-up was 18 months. (range 3–36 months) Average follow-up 22.1 months

Results: 149 (70%) out of 214 implanted patients suffered from a complex pain pattern syndrome with a mixture of nociceptive back pain und neuropathic leg pain. The VAS score reduction was 73% 29 patients (13.5%) had a complete lost of pain relief after 18 month. Complications occurred with lead breakage 5.63%, infektion 2.34%, dislocation 1.87%.

Conclusions: Our data shows this minimally invasive percutaneous approach to be effective and safe. Placement was done under local anesthesia, which allows intraoperative testing of the paraesthesia coverage for optimal clinical outcome. The lead migration rate was 1.87%. (4 cases) Lead revisions and/or necessary explanations can be performed percutaneously and without complications. Slimline paddle leads produce successful clinical outcomes, including 73% VAS score reduction and average paraesthesia coverage of 87.2%. More than 75% of the patients have stable results in the therapy after 36 month.