The Use of Intraoperative Electrophysiology for the Placement of Spinal Cord Stimulator Paddle Leads Under General Anesthesia

摘要

BACKGROUND: Placement of spinai cord stimulating paddle leads has traditionally been performed under local anesthesia with intravenous sedation to allow intra-operative confirmation of appropriate placement. It may be difficult to maintain appropriate sedation in certain patients because of medical comorbidities. Furthermore, patients undergoing lead revision frequently have extensive epidural scarring, requiring multilevel iaminectomies to place the electrode appropriately.To report our technique of neurophysiologic monitoring that allows these procedures to be performed under general anesthesia.Data from 78 patients who underwent eiectromyography during lam-inectomy for paddle lead placement were retrospectively reviewed. Seventy patients presented for first-time permanent system placement after a successful trial, and 8 were referred for revision or replacement of previously functioning systems. Surgeries were performed under general anesthesia with fluoroscopic guidance. Eiectromyography was used to help define the physiological midline of the spinal cord and to guide appropriate lead placement. Somatosensory evoked potentials were used as an adjunct to minimize the possibility of neural injury.RESULTS: Immediately postoperativeiy, 75 of 78 patients reported that the paresthesia coverage was as good as (or better than) that of the spinal cord stimulation trial. At the long-term follow-up, 1 system was removed for infection, and 6 systems were explanted for lack of efficacy. A total of 64 of the 78 implanted patients reported continued pain relief with stimulator use. Revision surgery was performed in 9 patients. The use of intraoperative electrophysiology for the placement of spinal cord stimulation paddle ieads under general anesthesia is a safe and efficacious alternative to awake surgery.