New technique for open placement of paddle-type spinal cord stimulator electrode in presence of epidural scar tissue.

Pabaney, Aqueel H; Robin, Adam M; Schwalb, Jason M

OBJECTIVES The objective of this study is to present a novel surgical technique for safe placement of paddle-type spinal cord stimulation (SCS) electrode in the presence of epidural scar tissue. MATERIALS AND METHODS We developed a new surgical technique for placement of paddle-type SCS electrode in presence of epidural scar tissue when conventional placement methods had failed. The technique involves creating a laminotomy trough to provide an adequate window for dissection of scar tissue to ensure safe placement of the electrode. We have applied this technique in eight patients. RESULTS Safe placement of SCS electrode was achieved in all eight patients without any complications. All electrodes were placed between T8 and T10 levels, and we were able to place the electrodes in the midline and achieve adequate coverage in all cases. CONCLUSION SCS is a widely accepted treatment modality for chronic neuropathic pain. Placement of paddle electrode can be challenging, usually because of the presence of epidural scar tissue. There have been reported cases of spinal cord injury related to paddle electrode placement. We present a novel technique that allows for safe placement of a paddle-type SCS electrode in more challenging surgical circumstances, including the presence of epidural scar tissue.