Case Series
A Novel Technique for the Implantation of Paddle Leads in the Cervical Spine

https://doi.org/10.1111/ner.12022Get rights and content

Objectives

Electrical spinal cord stimulators are routinely used in the thoracic spine for back and lower extremity pain. The anatomy of the cervical spine differs significantly from that of the thoracic spine and deserves special considerations if these implants are to be inserted safely in the neck. This paper explores the technical challenges of implanting paddle leads in the cervical spine and offers a novel technique for implantation.

Materials and Methods

Thirty-four patients underwent implantation of permanent spinal cord stimulators in the cervical spine by the same surgeon. The ages ranged from 26 to 59 with an average age of 45 years. Fifty-three percent of the patients were female, and 47% were male. Nineteen patients received St. Jude Exclaim leads; 15 patients received Boston Scientific Artisan leads. Mechanical failure of the device was the end point.

Results

Eleven of the 34 patients (32%) required removal or revision of the device for mechanical failure. Forty percent of the Boston Scientific patients had mechanical failures compared with 25% of the St. Jude patients (p = 0.73). When the Boston Scientific patients were compared with the St. Jude patients with the newer technique of implantation (mechanical failure = 0), the p value was 0.06.

Conclusion

A new technique is presented that allows easy and reliable implantation of cervical paddle leads in the neck with a low risk of iatrogenic complications.

Section snippets

INTRODUCTION

Neuromodulation has been used successfully to treat many chronically painful conditions, such as failed back surgery syndrome (1), chronic regional pain syndrome (2), and ischemic limb pain (3). The technique for introducing permanent spinal cord paddle stimulator leads in the thoracic spine is well established (4). With the success of neuromodulation for painful conditions of the back and lower extremities has come interest in using these devices for similar conditions in the neck and upper

MATERIALS AND METHODS

This is a case series review of the author’s experience with the implantation of permanent spinal cord stimulator paddle leads in the cervical spine specifically looking at mechanical failures. From January 2009 to January 2012, 545 spinal cord stimulator paddle leads were either inserted or revised by the author. Of these, 513 were implanted in the thoracic spine, and 34 were implanted in the cervical spine.

RESULTS

There were no dural tears, cerebrospinal fluid (CSF) leaks or neurologic complications in this series. All wounds, except one (an infection), healed primarily without incident. Eleven (32%) of the 34 patients required removal or revision of their cervical spinal cord stimulators within one month of insertion. Six (40%) of the 15 patients with a Boston Scientific lead required removal or revision. One was removed for infection. This was an unusually long procedure due to difficulty positioning

DISCUSSION

There is not much literature devoted to cervical spinal cord stimulation. The majority that does exist deals with the implantation of percutaneous leads. Most of the remaining papers lump thoracic and cervical implants together. Details of the surgical technique used and the complications are not distinguished between the thoracic groups and the cervical groups.

Displacement of the stimulator leads is not an uncommon cause of failure of cervical spinal cord stimulation. Robaina et al. (5)

Authorship Statement

Dr. Amrani was the sole author of this submission and responsible for the manuscript and data presented.

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Phoenix, AZ, USA

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