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KMID : 1040020140050010018
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International Journal of Pain
2014 Volume.5 No. 1 p.18 ~ p.25
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Placement of Multicolumn Paddle Leads for Spinal Cord Stimulation under General Anesthesia with Compound Muscle Action Potentials Monitoring: Technical Note
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Kim Young-Goo
Na Young-Cheol
Chang Won-Seok
Jung Hyun-Ho
Chang Jin-Woo
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Abstract
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Background: Spinal cord stimulation (SCS) using multicolumn paddle leads has shown benefits in axial back pain control and a lower complication rate of migration. However, this kind of surgical lead is not suitable for conducting the standard awake procedure. To overcome the weakness of the surgical lead, we describe our experience of a technique of multicolumn paddle lead placement for SCS monitoring with compound muscle action potentials (CMAPs) under general anesthesia.
Methods: We retrospectively reviewed a consecutive series of nine patients who underwent placement of multicolumn paddle leads for SCS under general anesthesia. Among the patients, five underwent the operation using CMAPs. A midline thoracic partial laminectomy was performed, and paddle SCS leads were placed. CMAPs of the anterior tibialis and abductor hallicus were analyzed. Final lead placement was determined by the right-to-left symmetry of the CMAPs in conjunction with C-arm fluoroscopic imaging. Stimulation-induced paresthesia coverage was evaluated postoperatively.
Results: The right-to-left symmetry of the CMAPs, at the physiologic midline, was confirmed in all patients during intraoperative monitoring. All five patients had adequate stimulation coverage, but two patients did not want permanent implantation.
Conclusions: Placement of multicolumn paddle leads under general anesthesia with CMAPs and C-arm fluoroscopic guidance could overcome the absence of patient feedback.
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KEYWORD
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spinal cord stimulation, general anesthesia, compound muscle action potential, multicolumn paddle leads, laminectomy
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