Research ArticleOriginal Research

Midline Minimally Invasive Placement of Spinal Cord Stimulators: A Technical Note

Edison P. Valle-Giler and Wale A. R. Sulaiman
Ochsner Journal March 2014, 14 (1) 51-56;

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Figures

  • Figure 1.
    Figure 1.

    Anteroposterior fluoroscopy showing the midline of the thoracic spine used as a reference to mark the skin.

  • Figure 2.
    Figure 2.

    Sequence of surgical steps in the minimally invasive surgery midline placement of a spinal cord stimulator (SCS). A: Ligamentum flavum at the level of the caudal aspect of the superior lamina once the laminectomy has been performed. B: The ligamentum flavum has been removed and the epidural space is shown. C: The SCS paddle lead has been placed in the epidural space. D: The SCS lead cables are secured in the 3-cm wound over the midline before tunneling them to the buttocks incision for connection to the pulse generator.

  • Figure 3.
    Figure 3.

    Anteroposterior illustration showing the paddle lead in the midline. With the laminectomy performed in the midline, the paddle lead is easily guided into the epidural space.

  • Figure 4.
    Figure 4.

    Illustration showing the laminectomy/removal of spinous processes at the thoracic spine. The ligamentum flavum has been removed and the paddle lead placed in the epidural space. The angle of the METRx-MD tube follows the angle of the spinous processes and the tube facilitates the placement of the spinal cord stimulator paddle lead in the epidural space. The inset image shows the location of the tube retractor in the midline where the lead will be placed.

  • Figure 5.
    Figure 5.

    A: Anteroposterior fluoroscopy showing the midline location of the tubular retractor system and the placement of the spinal cord stimulator (SCS) paddle lead in the midline. B: Lateral fluoroscopy showing the tubular retractor between the 2 adjacent spinous processes and the paddle lead in the epidural space. The position of the tubular retractor system is 1 vertebral level below the desired position of the SCS paddle lead and is oblique.

  • Figure 6.
    Figure 6.

    Illustration of the spinal cord stimulator (SCSs) system once it has been implanted. We prefer to position the battery on the superior aspect of the buttocks, inferior to the waistline, where the device is associated with fewer complaints from patients.

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