Decreased Radiation Exposure with Percutaneous Shielded Lead Compared to Unshielded Implant for Spinal Cord Stimulation

Abstract

Background: Spinal cord stimulation (SCS) is a safe and effective treatment for refractory failed back surgery syndrome (FBSS). Two implantation procedures exist depending on the use of a surgical versus percutaneous lead. Percutaneous leads implantation is less invasive but the placement procedure requires a higher X-ray exposure. The new MRI compatible shielded percutaneous leads (Vectris®) appear to be stiffer and therefore seem to be easier to implant compared to unshielded percutaneous electrodes (Octad®). The aim of this study is to compare the radiation exposure between percutaneous shielded leads and percutaneous unshielded leads in SCS implantation. Setting: Retrospective study. Material and methods: 20 patients successively underwent SCS for FBSS. The first 10 patients were implanted with an Octad ® lead and the 10 following with a shielded Vectris ® lead. All patients were operated on by the same surgical team. In all cases, the same intra-operative X-rays device (Ziehm Vision 8000®) was used, with identical parameters aiming at a minimal X-rays exposure (pulse mode with 2 impulses/sec, and automatic mode for kVp and mAs). Results: Fluoroscopy time was significantly lower in patients implanted with the Vectris® lead (mean: 99 seconds) compared to the Octad® lead (mean: 291 seconds) (p=0.0035). Subsequently, total patient X-rays exposure in the Vectris group (mean 592 cGycm2) was significantly lower than in the Octad® group (mean: 1899 cGycm2) (p=0.0005). Conclusion: The use of MRI compatible shielded percutaneous leads significantly reduces the fluoroscopy time and the total X-ray exposure in SCS implantation.