Placement of a dorsal column stimulator4/11/2024 In addition, the percutaneous leads have demonstrated improved durability or reduced risk of breakage compared to the alternative, laminotomy technique. Furthermore, the less invasive, percutaneous lead placement can typically be done in an outpatient setting, which reduces inherent risks associated with an extensive surgery (infection, duration of anesthesia, post-operative pain, etc.). However, due to the invasiveness of the aforementioned technique, the percutaneous (octrode) or linear arrangement of conductors and insulators by a midline anchoring placement has become more popular. This has historically been achieved by using a flat, two-dimensional insulated electrode, or paddle lead (lamitrode) placed via laminotomy. Implantation techniques differ and depend largely on surgeon preference as well as institutional protocol. The superiority of spinal cord stimulation compared with conservative treatment (particularly for failed back surgery syndrome) has been evidenced by two randomized controlled trials, detailing the effectiveness in pain improvement and functional outcomes. A few of the many benefits of spinal cord stimulation are cost-effectiveness, improvement in quality of life, and decreased amounts of pain medications prescribed for patients. Spinal cord stimulation, a form of neuromodulation, has become an effective modality for treating chronic pain conditions since the 1960s. The operative technique was documented with images and detailed descriptions at the authors home institution. This technical description provides the first, easily accessible technical guide for the percutaneous placement of thoracic spinal cord stimulators. However, detailed and indexed techniques of the percutaneous alternative are lacking. The traditional laminotomy approach for paddle lead placement has been well described in the literature. These features make the percutaneous method an appealing alternative to the traditional laminotomy technique. Additionally, the percutaneous leads have a smaller footprint in the epidural space, allowing more patients with mild spinal canal stenosis to receive this therapeutic device, which generally precludes paddle placement. The percutaneous technique allows for decreased operative times and thus reduced anesthesia, as well as decreased post-operative pain due to less tissue and muscle dissection. With appropriate patient consent for photography during the operation per hospital policy, the technical description for percutaneous placement of a spinal cord stimulator was documented at the authors home institution. The superiority of this therapeutic strategy is in part due to the many benefits, such as decreased use of prescription pain medications, cost-effectiveness, and improvement in patient quality of life. Spinal cord stimulation is a safe, effective, and reversible method for the management of chronic neuropathic pain. Spinal cord stimulation was found to be superior to traditional conservative management in recent clinical trials.
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