Anterograde and retrograde epidural paddle placement through a single laminotomy for the treatment of back and lower extremity pain using spinal cord stimulation: case reports and technical note.

Abstract

Spinal cord stimulation can be effectively used in the treatment of low back pain and extremity pain in failed back surgery syndrome. Ideal targets for stimulation corresponding to paresthesia overlap in the low back versus the extremities may differ in cranial-caudal location. We present here a technical report of three cases demonstrating a technique to place anterograde and retrograde epidural paddles through a single laminotomy. Using this technique we were able to cover five spinal levels in each patient, and different stimulation programs at different levels created paresthesia overlap in back versus lower extremity in those patients. Dual paddle placement through a single laminotomy may be a reasonable option for select patients where coverage of anatomically-separated pain regions is necessary. This technique can be performed in most patients without significantly increased morbidity.