![]() ![]() ![]() This study characterizes the safety profile of SCS paddle replacement surgeries. Despite the invasive nature of paddle replacement, there was no difference in complications (p = 0.23) compared with that in percutaneous leads. Paddle re-operations lasted in general 1.7 ± 0.2 hours and had 35 ± 5 mL of blood loss, whereas percutaneous operations lasted 1.3 ± 0.2 hours and had 12.5 ± 2 mL of blood loss. Re-operations that occurred more than one year after initial implant were significantly more likely to require additional bone removal (p < 0.001). A total of 30 of the 51 paddle replacements required additional lamina removal. Most paddles (48/51) were replaced at the time of removal. Of these, 73 involved replacement of epidural leads (51 paddles, 22 percutaneous). Percutaneous lead replacement cases performed over the same period were used as a comparison group.Ī total of 1265 patients were identified to have had an SCS-related procedure based on billing codes. The medical records were reviewed for demographic data and information regarding initial complications, reason for removal or revision, subsequent complications of replacement surgery and its timing, and whether the implant was ultimately removed. Participants who underwent SCS replacement at Albany Medical Center between 20 were identified. In this study, we share our experience on SCS paddle replacement. However, there is concern for how safely SCS paddles can be replaced once previously implanted because of scar tissue and the relative vulnerability of the thoracic cord. The patient was discharged home the following day without further sequelae.Paddle leads for spinal cord stimulation (SCS) offer more efficient energy delivery and advantages in some patients. We then affixed the leads to the T11 lamina using a 16 mm craniomaxillofacial low-profile plate. When placing a new epidural paddle electrode, we encountered significant adhesions in the epidural space requiring additional laminotomies at T8–T9 and T9–T10 to adequately dissect the adhesions and place the epidural paddle electrode. Upon return to the operating room, we were able to retract the paddle electrode to the level of T5 where we encountered resistance therefore, we performed a laminotomy at this level to remove the paddle electrode. A thoracic X-ray revealed that the epidural paddle electrode had migrated to the cervical C6-C7 epidural space. When he returned 15 days later, he no longer experienced pain relief and reported consistent stimulation in upper extremities. The lead was secured to the ligamentum flavum with 4-0 NUROLON sutures. Ten days later, we placed an epidural paddle electrode through a T10–T11 laminotomy. With no improvement 6 months after surgery, we offered a trial of SCS, and he experienced significant relief from the back and leg pain. Keywords: Failed back surgery syndrome, Hardware failure, Lead migration, Spinal cord stimulation, StimulatorĪ 53-year-old male underwent a right L4-L5 microdiscectomy and foraminotomy and was discharged home the same day. It was subsequently removed and replaced into the thoracic region, but the leads were now secured in place with a novel caudal lamina/cranial plating system. ![]() The patient subsequently did well without further sequelae.Ĭonclusions: A thoracic epidural paddle (T10–T11) migrated postoperatively into the cervical spine. The stimulator/new paddle was placed again at the T10–T11 level, but the leads were now secured to the caudal lamina utilizing a cranial plating system. An X-ray demonstrated cranial migration of the thoracic epidural paddle to the cervical spine. However, postoperatively, he complained of paresthesias in his arms. Here, we present a case of cranial migration of a thoracic epidural paddle to the cervical spine.Ĭase Description: A 53-year-old male underwent uncomplicated spinal cord stimulator placement at the T10– T11 with initially favorable results. Background: Spinal cord stimulators successfully treat a number of pain syndromes but carry a risk of hardware complications. ![]()
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