Literature showed that the paddle leads are more effective than the percutaneous catheters in FBSS treatment in terms of pain relief and cost-effectiveness. The radiological assessment showed that no paddle displacement occurred and no signs of segmental instability were observed. The other five patients underwent the IPG implant (two, Synergy Versitrel – three, Prime Advanced).Īfter 2 months no patient complained of local pain where the interlaminotomy was performed. The postoperative X-rays showed the correct position of the plates.Īfter the epidural trial, we removed 1 Hinged 4 + 4 because ineffective and 1 Specify 5 + 6 + 5 because of an infection. We did not have any intraoperative problem during surgery technique related.Īll patients stood up on the same day of surgery and were discharged within 48-72 hours without neurological deficits or wound problems. In one case a unilateral approach was converted to a bilateral to achieve a median position of the electrode. In all cases the paddle leads (3 Hinged 4 + 4 and 4 Specify 5 + 6 + 5) were implanted through uni- or bilateral interlaminotomy with complete preservation of the supraspinous ligament. (a) unilateral paraspinal muscles dissection (b) interlaminotomy: Flavectomy and minimal resection of both inferior lamina of D9 (or D10) and superior lamina of D10 (or D11) b] slightly extended controlaterally under the midline ligamentous structures c) a space to introduce the lead blank is obtained completely preserving the supraspinous ligament b] (d) paddle lead insertion in median position with unilateral release of the two extension cables that are later fixed to muscular fascia and (e) trial pulse generator standard connection. We performed the unilateral approach in two cases. Controlateral extension of the exposure under the midline ligamentous structures (blue star), (c) Lead blank insertion through the interlaminotomy, (d) Lead paddle insertion through the interlaminotomy Supraspinous ligament structures are preserved (white star). (a-b) Monolateral interlaminotomy with dura mater exposed (white arrow). The clinical efficacy of SCS in terms of pain relief is not debated. We presented our preliminary findings and discussed advantages and limitations of this microinvasive technique. Aim of the study was to assess if a minimally invasive approach may allow reducing spinal instability and local pain after surgery. In our Neurosurgical Division SCS for FBSS was performed in 19 patients through a uni- or bilateral laminotomy or a partial laminectomy. In contrast, a bilateral laminotomy with midline structures preservation may ensure the spinal stability and this is confirmed by biomechanical experimental tests carried out on animal models. The paddle lead is usually implanted through a bilateral flavectomy and partial laminectomy with midline ligamentous structures resection. A systematic review of the English language literature from 1996 to 2008 evaluating the effectiveness of SCS in relieving chronic pain in FBSS indicated the evidence to be level II-1 or II-2. As a matter of fact, several authors reported better coverage of pain and clinical outcome with fewer adverse effects. Insulated arrays implanted via laminectomy demonstrated performance advantages, in comparison with percutaneous electrodes. Spinal cord stimulation (SCS) is an effective therapy in chronic intractable pain of failed back surgery syndrome (FBSS) with pain relief rates between 50% and 75% in long-term follow-up.
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