Abstract
Object. We arranged a mini-invasive surgical approach for implantation of paddle electrodes for SCS under spinal anesthesia obtaining the best paddle electrode placement and minimizing patients' discomfort. We describe our technique supported by neurophysiological intraoperative monitoring and clinical results. Methods. 16 patients, affected by neuropathic pain underwent the implantation of paddle electrodes for spinal cord stimulation in lateral decubitus under spinal anesthesia. The paddle was introduced after flavectomy and each patient confirmed the correct distribution of paresthesias induced by intraoperative test stimulation. VAS and patients' satisfaction rate were recorded during the followup and compared to preoperative values. Results. No patients reported discomfort during the procedure. In all cases, paresthesias coverage of the total painful region was achieved, allowing the best final electrode positioning. At the last followup (mean 36.7 months), 87.5% of the implanted patients had a good rate of satisfaction with a mean VAS score improvement of 70.5%. Conclusions. Spinal cord stimulation under spinal anesthesia allows an optimal positioning of the paddle electrodes without any discomfort for patients or neurosurgeons. The best intraoperative positioning allows a better postoperative control of pain, avoiding the risk of blind placements of the paddle or further surgery for their replacement.
Highlights
Spinal cord stimulation (SCS) is a widely established therapy for chronic neuropathic pain [1, 2]
Even if several mechanisms cooperate in pain relief provided by SCS, the activation of the A-beta fibers is considered to be the main mechanism [2, 5]
All the patients have a history of neuropathic pain due to different causes, which irradiate to one or both inferior limbs, nonresponsive to the conventional therapies (14 failed back surgery syndrome; 1 multiple sclerosis; 1 luetic arachnoiditis) (Table 1) [7, 10]
Summary
Spinal cord stimulation (SCS) is a widely established therapy for chronic neuropathic pain [1, 2]. This technique was proposed by Shealy [3] and is based on Melzack and Wall’s gatecontrol theory [4]. The stimulation was delivered using paddle electrodes inserted by means of a surgical operation, but in the early ’70s percutaneous spinal catheter leads were developed. These two techniques are both still used, but with different indications. The possibility to keep the patient awake enables the surgeon to verify the coverage of the painful areas “online”, asking directly the patient about the paresthesias distribution and achieving the optimal placement of the electrodes
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