Paddle Versus Cylindrical Leads for Percutaneous Implantation in Spinal Cord Stimulation for Failed Back Surgery Syndrome: A Single-Center Trial

Thomas M. Kinfe; Florian Quack; Christian Wille; Stefan Schu; Jan Vesper

doi:10.1055/s-0034-1371517

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

J Neurol Surg A Cent Eur Neurosurg 2014; 75(06): 467-473
DOI: 10.1055/s-0034-1371517

Technical Note

Georg Thieme Verlag KG Stuttgart · New York

Paddle Versus Cylindrical Leads for Percutaneous Implantation in Spinal Cord Stimulation for Failed Back Surgery Syndrome: A Single-Center Trial

Thomas M. Kinfe

¹Division of Functional Neurosurgery and Neuromodulation, Department of Neurosurgery, Rheinische Friedrich Wilhelms University Bonn, Bonn, NRW, Germany

,

Florian Quack

²Division of Functional Neurosurgery and Neuromodulation, Department of Neurosurgery, Heinrich Heine University, Duesseldorf, NRW, Germany

,

Christian Wille

²Division of Functional Neurosurgery and Neuromodulation, Department of Neurosurgery, Heinrich Heine University, Duesseldorf, NRW, Germany

,

Stefan Schu

²Division of Functional Neurosurgery and Neuromodulation, Department of Neurosurgery, Heinrich Heine University, Duesseldorf, NRW, Germany

,

Jan Vesper

²Division of Functional Neurosurgery and Neuromodulation, Department of Neurosurgery, Heinrich Heine University, Duesseldorf, NRW, Germany

› Author Affiliations

Abstract

Objective Spinal cord stimulation is an interventional treatment for chronic pain syndromes such as failed back surgery syndrome (FBSS), and it utilizes either cylindrical or paddle electrodes placed percutaneously into the epidural space. This prospective nonrandomized single-center study investigated the specific advantages and disadvantages of percutaneously implanted paddle and cylindrical leads in patients with FBSS.

Methods Over a 2-year period, 100 patients with FBSS (43 men; 57 women; mean age: 56.3 years) were included. Paddle leads were placed percutaneously under local anesthesia in 50 patients; conventional percutaneous cylindrical lead implantation was performed in the other 50 patients (one lead permitted per patient). Follow-up included the Visual Analog Scale (VAS) assessment of pain and administration of the Oswestry Disability Questionnaire.

Results Similar significant pain reduction (69%) was demonstrated in both groups (VAS pre/post: paddle: 8.8/3.7; cylindrical: 8.5/3.8). Using the same perioperative protocol for each group, we observed higher dislocation and infection rates for the cylindrical group (14% and 10%, respectively) than for the paddle group (6% and 2%, respectively).

Conclusion Minimally invasive percutaneous paddle and cylindrical leads are safe and effective, have low complication rates, and perform well in patients with FBSS. Both devices can be implanted using a local anesthetic, so that intraoperative and reproducible testing stimulation can be performed for sufficient paresthesia overlap prior to permanent device fixation.

Keywords

percutaneous implantation technique - paddle lead - cylindrical lead - spinal cord stimulation - intractable pain

Full Text

References

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