Permanent Paddle-lead Trial for Spinal Cord Stimulation

Abstract

Objectives A significant number of chronic pain patients rely on spinal cord stimulation (SCS) for treatment of their intractable pain. A screening trial using percutaneous electrodes is an integral step for predicting a successful treatment course with a permanent SCS system. Most of these trials are performed in an outpatient ambulatory surgical center and some in the office setting. However, there are select patients who are considered poor candidates for percutaneous trials. We present the initial report of patients who have received surgical implantation of permanent paddle-leads for SCS trials at our institution and show that this was a safe and effective alternative for our patients who could not undergo percutaneous trials.  Methods We retrospectively reviewed the hospital charts of 12 patients who underwent permanent surgically-implanted paddle-lead trials from 2014 to 2017. Success was considered positive with a 50% reduction in pain rating. If positive, patients were brought back to the operating room to have the implanted leads connected to an internalized pulse generator.    Results All 12 patients met the criteria for a successful trial. Only one patient had his SCS system surgically removed after nine months. None of our patients reported or returned with paddle-lead migrations or infections.  Conclusions We report that surgically-implanted paddle-lead trials were a safe and effective alternative to percutaneous trials in our patients who were deemed poor candidates for percutaneous trials. No complications occurred and all of our patients received a second surgery for internalization of the SCS system. Patients who have previously failed percutaneous trials may be false-negatives to SCS.