![]() We placed all paddle leads with patients under general anesthesia and in a prone position on either a Wilson frame or Jackson table. The study was approved by our institutional review board. Informed consent was obtained in all cases. This article illustrates the technique and reviews the perioperative data of patients from 2010 to 2013 who underwent surgery with this technique.Īll patients had successful trials (>50% pain relief) of SCSs performed by their pain specialists prior to being referred for placement of permanent paddle lead via laminectomy. A prospective database of all patients who had paddle leads placed using the new technique was maintained. In an attempt to reduce operative times, estimated blood loss, and postoperative pain from muscle dissection and to ease the technical challenges of placing the paddle lead in the midline via a paramedian and off-midline incision, we designed a new MIS technique to place the paddle lead using a tubular retractor system (METRx-MD Medtronic) through a true midline approach. Because of the locations of the incision and the laminectomy, accurate midline positioning of the paddle lead is often difficult to achieve. 7- 11 These techniques have been performed using the conventional steps described for an MIS laminectomy: creating a window at the lateral aspect of the lamina and passing the paddle lead through the opening in an attempt to place it in a midline position. Recently, multiple minimally invasive surgery (MIS) techniques have been described to place SCS paddle leads in the epidural space in an attempt to decrease the patient's postoperative pain and to reduce the length of the hospital stay. This approach could contribute to worsening the pain syndrome in patients who experience chronic pain and also increases medical costs when patients have to stay in the hospital for 1 or 2 days for pain management. ![]() 1- 6 Stimulators were conventionally implanted through open approaches with extensive muscle dissection to perform 1- or 2-level laminectomies and permanently place the paddle lead. Spinal cord stimulators (SCSs) have been used for decades to treat chronic pain syndromes. ![]()
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