Subdural Cervical Spinal Cord Stimulator Lead Placement Leading to Progressive Neurologic Symptoms

2020 ◽  
Author(s):  
Jery D. Inbarasu ◽  
Jonathan M. Hagedorn
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Spinal Cord Stimulator ◽  
Neurologic Symptoms ◽  
Lead Placement

Localization of cervical and cervicomedullary stimulation leads for pain treatment using median nerve somatosensory evoked potential collision testing

2011 ◽  
Vol 114 (1) ◽  
pp. 200-205 ◽  
Author(s):  
Jeffrey R. Balzer ◽  
Nestor D. Tomycz ◽  
Donald J. Crammond ◽  
Miguel Habeych ◽  
Parthasarathy D. Thirumala ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Evoked Potential ◽  
Cervical Spinal Cord ◽  
Pain Syndrome ◽  
Somatosensory Evoked Potential ◽  
Spinal Cord Stimulator ◽  
Epidural Stimulation ◽  
Pain Syndromes ◽  
Lead Placement ◽  
Patient Reported

Object Spinal cord stimulation (SCS) is being currently used to treat medically refractory pain syndromes involving the face, trunk, and extremities. Unlike thoracic SCS surgery, during which patients can be awakened from conscious sedation to confirm good lead placement, safe placement of paddle leads in the cervical spine has required general anesthesia. Using intraoperative neurophysiological monitoring, which is routinely performed during these cases at the authors' institution, the authors developed an electrophysiological technique to intraoperatively lateralize lead placement in the cervical epidural space. Methods Data from 44 patients undergoing median and tibial nerve somatosensory evoked potential (SSEP) monitoring during cervical laminectomy or hemilaminectomy for placement or replacement of dorsal column stimulators were retrospectively reviewed. Paddle leads were positioned laterally or just off midline and parallel to the axis of the cervical spinal cord to effectively treat what was most commonly a predominant unilateral pain syndrome. During SSEP recording, the spinal cord stimulator was activated at 1.0 V and increased in increments of 1.0 V to a maximum of 6.0 V. A unilateral reduction or abolishment of SSEP amplitude was regarded as an indicator of lateralized placement of the stimulator. A bilateral diminutive effect on SSEPs was interpreted as a midline or near midline lead placement. Results Epidural stimulation abolished or significantly reduced SSEP amplitudes in all patients undergoing placement for a unilateral pain syndrome. In 15 patients, electrodes were repositioned intraoperatively to achieve the most robust SSEP amplitude reduction or abolishment using the lowest epidural stimulation intensity. In all cases in which a significant unilateral reduction in SSEP was observed, the patient reported postoperative sensory alterations in target locations predicted by intraoperative SSEP changes. Placement of cervical spinal cord stimulators for bilateral pain syndromes often resulted in bilateral but asymmetrical SSEP changes. In no cases were significant SSEP changes, other than those induced using the device to directly stimulate the dorsal surface of the spinal cord, observed. No case of new postoperative neurological deficit was observed. Conclusions Somatosensory evoked potentials can be used safely and successfully for predicting the lateralization of cervical spinal cord stimulator placement. Moreover, they can also intraoperatively alert the surgical team to inadvertent displacement of a lead during anchoring. Further studies are needed to determine whether apart from assisting with proper lateralization, SSEP collision testing may help to optimize electrode positioning and improve pain control outcomes.

scholarly journals Alternative Approach To Needle Placement In Cervical Spinal Cord Stimulator Insertion

2011 ◽  
Vol 3;14 (2;3) ◽  
pp. 195-210
Author(s):  
Jie Zhu
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Spinal Cord Stimulation ◽  
Cervical Spinal Cord ◽  
Spinal Cord Stimulator ◽  
Needle Placement ◽  
Lead Placement ◽  
Loss Of Resistance ◽  
Technical Report ◽  
Failed Back Surgery

Background: Neuromodulation with spinal cord stimulation is a proven cost effective treatment for the management of common conditions such as chronic radicular leg pain from failed back surgery syndrome, complex regional pain syndrome, and other painful neuropathic pain syndromes. The traditionally instructed method for percutaneous spinal cord stimulator (SCS) lead placement promotes the use of a “loss of resistance” (LOR) technique under anteroposterior (AP) fluoroscopic guidance to assure midline lead placement and proper entry into the epidural space. Objective: To describe the relevant anatomy and method for a precise needle placement approach for placement of percutaneous cervical spinal cord stimulation (SCS) leads without loss of resistance (LOR) using a syringe. An oblique fluoroscopic view is presented demonstrating successful placement of cervical SCS leads. Design: Technical report. Setting: Pain management clinic. Methods: Discussion with accompanying fluoroscopic images. This technical report meets HIPAA compliance standards. Results: Successful placement of percutaneous SCS leads without traditional loss of resistance using an oblique fluoroscopic approach. Limitations: Technical report only. The risks, potential complications, and benefit from this approach are beyond the scope of the article. Conclusions: This fluoroscopic technique provides an alternative means for placing percutaneous cervical SCS leads without the use of the traditional loss of resistance technique. Key words: spinal cord stimulation, neuromodulation, cervical spine, fluoroscopy, loss of resistance, epidural injection, neuropathic pain, failed neck surgery.

Implantation of a Thoracic Spinal Cord Stimulator Paddle Electrode and Generator Under General Anesthesia With Intraoperative Neuromonitoring: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (6) ◽  
pp. E169-E169 ◽  
Author(s):  
Lauren E Stone ◽  
Steven M Falowski
Keyword(s):  
Spinal Cord ◽  
Video Recording ◽  
Intraoperative Neuromonitoring ◽  
The Body ◽  
Spinal Cord Stimulator ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Lead Placement ◽  
Patient Consent ◽  
Spinal Flexibility

Abstract Spinal cord stimulation is a well-established and effective therapy in the treatment of pain. Proper patient selection and accurate lead placement are paramount in its success. Placement is a multifaceted process requiring proper paddle placement, a well thought out generator placement and appropriate means to limit complications and enhance success. Several intraoperative techniques maximize outcomes, including removal of the superior portion of the inferior level's spinous process for paddle access into the epidural space, generator pocket placement in a location that limits patient discomfort, a strain relief loop at the thoracic incision to prevent lead fractures and allow for full spinal flexibility, generator placement parallel to the body and secured in the pocket to prevent unwanted movement, and intraoperative neuromonitoring for patient comfort and more accurate lead placement compared to X-ray alone or awake placement. This case demonstrates these key elements of intraoperative technique in a candidate with the most common indication for spinal cord stimulator placement–postlaminectomy syndrome–underscoring the ease and viability of this procedure in the appropriate patient population in a means that reduces future complications and adverse events while maximizing success.  Full patient consent for video-recording and subsequent use for research purposes was attained. All patient identifiers have been removed for the purpose of patient confidentiality.

scholarly journals Laminoplasty for Cervical Spinal Cord Stimulator Implantation in Patients With Cervical Spondylosis and Fusion: A Technical Note

2019 ◽  
Vol 19 (1) ◽  
pp. 38-42
Author(s):  
Daniel J. Denis ◽  
Tianyi Niu ◽  
Pierre-Olivier Champagne ◽  
Daniel C. Lu
Keyword(s):  
Spinal Cord ◽  
Cervical Spondylosis ◽  
Cervical Spinal Cord ◽  
Technical Note ◽  
Spinal Cord Stimulator

scholarly journals Reversible Horner’s syndrome after cervical spinal cord stimulator implantation in a patient with complex regional pain syndrome

2018 ◽  
Vol Volume 11 ◽  
pp. 3019-3023
Author(s):  
Jaeyoung Yang ◽  
Yusun Choi ◽  
Juyoung Park ◽  
Junhyug Jeong ◽  
Bousung Lee ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Complex Regional Pain Syndrome ◽  
Cervical Spinal Cord ◽  
Pain Syndrome ◽  
Spinal Cord Stimulator

scholarly journals Case Series on Variable Presentation of Ligamentum Flavum Stimulation Following Percutaneous Cylindrical Spinal Cord Stimulator Lead Implants

2014 ◽  
Vol 3;17 (3;5) ◽  
pp. E397-E403
Author(s):  
Dr. Susie S Jang
Keyword(s):  
Spinal Cord ◽  
Time Course ◽  
Ligamentum Flavum ◽  
Case Series ◽  
Pain Clinic ◽  
Spinal Cord Stimulator ◽  
Retrospective Case ◽  
Background Stimulation ◽  
Lead Placement ◽  
Time Periods

Background: Stimulation-evoked discomfort secondary to ligamentum flavum stimulation (LFS) is a technological limitation of percutaneous spinal cord stimulator (SCS) lead implants. There is a paucity of literature describing the clinical presentation and time periods at which this side effect may present following insertion of cylindrical lead(s). Objective: To describe a series of 5 patients who presented at varying time periods after SCS lead placement with LFS. Study Design: Retrospective case series. Methods: We performed a chart review of online medical records of patients with symptoms consistent with LFS at an academic interventional pain clinic identified over 7 consecutive years (2006 - 2013). Results: LFS most frequently presented within months of implantation of cylindrical leads. One patient complained of LFS during the temporary trial while another developed LFS after lead revision. All patients were successfully treated when paddle electrodes replaced percutaneous cylindrical leads. Conclusion: LFS may present as a barrier to successful SCS treatment. Clinicians placing percutaneous SCS leads should be aware of the variable time course of LFS presentation. Paddle style electrodes seem to offer an enduring solution to LFS so that patients may continue to benefit from SCS therapy. Key words: Percutaneous electrodes, cylindrical electrode, paddle electrodes, ligamentum flavum stimulation, unwanted stimulation

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