Awake Implantation of Thoracic Spinal Cord Stimulator Paddle Electrode and Generator: 2-Dimensional Operative Video : Operative Neurosurgery

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Awake Implantation of Thoracic Spinal Cord Stimulator Paddle Electrode and Generator: 2-Dimensional Operative Video

Chen, Kevin S MD; Sagher, Oren MD,

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Operative Neurosurgery 17(3):p E100, September 2019. | DOI: 10.1093/ons/opy376
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In this surgical video, the operative technique is presented for awake implantation of a thoracic paddle electrode for spinal cord stimulation. In the first stage, a laminotomy is performed with the patient under conscious sedation. Once the paddle is in optimal position, the patient is tested intraoperatively to confirm adequate coverage and absence of untoward side effects. This paddle electrode is used for the trial period. If the patient derives satisfactory pain relief during the trial, they are returned for the second stage implantation of pulse generator, without moving the initial paddle electrode now already placed in an optimal location. Particular attention in this video is provided toward the optimal positioning and technique for the awake laminotomy to ensure patient comfort and reliability during testing, the use of extension leads tunneled opposite the planned pulse generator site, and the method of removing extension leads to preserve the placement of the initial paddle electrode.

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The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.


One can debate whether or not trials for spinal cord stimulation should be performed using paddle leads. There is increased risk and cost associated with this compared to trials performed with percutaneous leads. In addition, if the trial is a failure the patient has to be brought back to the operating room for extraction of the paddle as opposed to a simple removal of percutaneous leads in an outpatient clinic.

That being said, the authors do a nice job in the video showing the patient set-up, relevant anatomy, and technical steps required to perform this safely. Paddle lead anchoring methods and management of the extension leads and connectors are nicely illustrated and can be helpful for other surgeons wishing to perform this procedure.

Naresh P. Patel

Phoenix, Arizona

Spinal cord stimulator electrode and generator implantation is far from standardized, and continues to have device-related complications. The literature is replete with surgical technique iterations, but this video clearly demonstrates all the steps and some tricks to implanting a neuromodulatory device in an awake patient. These types of videos coupled with reported complication rates will, in the future, improve the granularity with which we judge surgical outcomes.

Jeffrey Steven Raskin

Indianapolis, Indiana


Spinal cord stimulation; Education; Medical; Surgical Procedures; Operative; Chronic pain

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