Multicolumn Spinal Cord Stimulation Surgical Lead Implantation Using an Optic Transligamentar Minimally Invasive Technique

Abstract

IntroductionA new generation of neurostimulation surgical leads is used to increase the success of spinal cord stimulation (SCS) in difficult-to-treat indications such as Failed Back Surgery Syndrome (FBSS). This makes the implant procedure more invasive, which is likely to be a determinant factor in clinical and functional outcomes. Minimal access spinal technologies (MAST) have been previously used for surgical lead implantation. However, only a unilateral approach was described, causing some difficulties for median lead placement and not always preventing laminectomy. A recent MAST technique can be used to implant SCS leads without these limitations, which seems to be key in the positive outcomes experienced. The objective is to describe the original MAST technique used in the pilot study. Material and MethodsTwenty-four consecutive patients were implanted with a multicolumn surgical lead for refractory chronic back and leg pain using the optic transligamentar MAST technique described extensively. Clinical outcomes, functional ability and adverse events (AEs), were recorded for up to 12 months after surgery. ResultsThe MAST technique allowed median lead placement, facilitated visualization of the spine and permitted transligamentar insertion that minimized scarring and muscle damage, intraoperative blood loss and postoperative functional complications. Back pain decreased significantly at all follow-up, while functional status improved significantly at 1 year. No technique-related AEs were reported. ConclusionUse of MAST approach could be useful in safe implantation of multicolumn surgical leads and confer major advantages in difficult-to-treat refractory lower back pain conditions such as FBSS