Feasibility and Long-term Outcomes of Minimally Invasive Tubular Spinal Cord Stimulation Lead Placement.

Abstract

Objectives: This study primarily addressed the feasibility of implanting a spinal cord stimulation (SCS) electrode in a minimally invasive tubular approach and the required frequency of escalating to a second tube or an open approach. It secondarily addressed the electrode placement in relation to the midline or to the side of the predominant pain, in addition to the long-term clinical outcomes.

Materials and methods: A retrospective chart review was conducted in patients who underwent minimally invasive tubular surgery with paddle electrodes for neuropathic pain between January 2017 and December 2023 in Halifax, Canada. Midline placement was assessed anatomically and physiologically with intraoperative imaging and compound muscle action potentials, respectively. Clinical outcomes were described by pre- and postoperative visual analog scale scores, patient satisfaction, and adverse reactions.

Results: In total, 25 participants were identified, and all surgeries proceeded without escalation. Anatomically, all but one electrode was placed fully or partially on the spinal midline. Physiologically, muscle activation favored the midline or the predominant pain side in 90% of cases. Four adverse reactions were reported within one year after surgery, one of which was classified as serious. Pre- and postoperative pain scores were significantly reduced from 7.2 ± 1.8 to 4.2 ± 2.5 (p < 0.001); 82.6% of the patients were very satisfied or somewhat satisfied and still using their device one year after surgery.

Conclusions: Minimally invasive tubular placement of SCS electrodes is shown here to be feasible, achieving satisfactory alignment and clinical outcomes. The lack of surgical escalation supports the minimally invasive claim. Midline placement was indicated anatomically and physiologically in most cases, and clinical decisions for impactful pain coverage accounted for most nonmidline placements. Clinically, patient-reported outcomes were largely positive.