Background: Lead migration is a frequent complication of spinal cord stimulation (SCS) and requires revision surgery. The evolution of wider paddle leads has necessitated more extensive laminotomy and epidural adhesiolysis, which may increase the risk of lead migration.
Objective: We describe a novel anchoringtechnique for SCS paddle leads using a cranial “dogbone” plate.
Methods: We retrospectively reviewed a consecutive series of 11 patients who underwent placement of paddle lead spinal cord stimulators with titanium plate anchoring.Patients were followed for a mean of 29.5 months from SCS implantation (range, 5-65 months).A 4-hole linear titanium cranial plate and two 4mm screws were used to tightly affix the proximal paddle lead wiring to the lamina below the laminotomy defect.
Results: All patients continue to have satisfactory spinal cord stimulation with no loss of efficacy or need for revision. No complications have been attributed to titanium plate anchoring, and there have been no cases of lead migration with this technique. Titanium plate anchoring added minimal time (approximately 3-5 minutes) to the operative case.
Conclusion: We report a safe and effective anchoring technique for paddle lead SCS using a cranial plate.Our experience has been that this technique, which anchors the proximal lead wiringto the remaining lamina at the inferior laminotomy defect, is superior to anchoring methods,which rely on suturing of lead wiring.
From: Cranial Plate Anchoring of Spinal Cord Stimulation Paddle Leads: Technical Note by Tomycz et al.