Department of Neurosurgery, Albany Medical College, Albany, NY, USA.
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.
Neuromodulation. 2022 Jul;25(5):753-757. doi: 10.1016/j.neurom.2022.02.228. Epub 2022 Apr 5.
Paddle leads for spinal cord stimulation (SCS) offer more efficient energy delivery and advantages in some patients. However, there is concern for how safely SCS paddles can be replaced once previously implanted because of scar tissue and the relative vulnerability of the thoracic cord. In this study, we share our experience on SCS paddle replacement.
Participants who underwent SCS replacement at Albany Medical Center between 2011 and 2020 were identified. The medical records were reviewed for demographic data and information regarding initial complications, reason for removal or revision, subsequent complications of replacement surgery and its timing, and whether the implant was ultimately removed. Percutaneous lead replacement cases performed over the same period were used as a comparison group.
A total of 1265 patients were identified to have had an SCS-related procedure based on billing codes. Of these, 73 involved replacement of epidural leads (51 paddles, 22 percutaneous). Most paddles (48/51) were replaced at the time of removal. A total of 30 of the 51 paddle replacements required additional lamina removal. Re-operations that occurred more than one year after initial implant were significantly more likely to require additional bone removal (p < 0.001). Paddle re-operations lasted in general 1.7 ± 0.2 hours and had 35 ± 5 mL of blood loss, whereas percutaneous operations lasted 1.3 ± 0.2 hours and had 12.5 ± 2 mL of blood loss. Despite the invasive nature of paddle replacement, there was no difference in complications (p = 0.23) compared with that in percutaneous leads.
This study characterizes the safety profile of SCS paddle replacement surgeries. Here, we demonstrate that the replacement of paddle leads at the time of removal, with additional lamina removal if needed because of scar, is associated with low rates of complications. This validates the feasibility and low-risk profile of replacing paddle leads when clinically indicated for experienced surgeons with specialization in SCS.
脊髓刺激（SCS）的桨式电极能更有效地传输能量，并能为部分患者带来优势。但是，人们担心一旦先前植入的电极因疤痕组织和相对脆弱的胸段脊髓而需要更换时，更换 SCS 桨式电极是否安全。在这项研究中，我们分享了我们在 SCS 桨式电极更换方面的经验。
确定 2011 年至 2020 年间在奥尔巴尼医疗中心进行 SCS 更换的参与者。对病历进行了回顾，以获取人口统计学数据以及有关初始并发症、移除或修改原因、更换手术的后续并发症及其时间以及植入物最终是否被移除的信息。同时还使用了同期进行的经皮导丝更换病例作为对照组。
根据计费代码，共确定了 1265 名接受过 SCS 相关治疗的患者。其中，73 例涉及硬膜外电极（51 个桨式，22 个经皮）的更换。大多数桨式电极（48/51）在移除时进行了更换。51 个桨式电极更换中有 30 个需要进一步切除椎板。初始植入后一年以上进行的再次手术，更有可能需要进一步的骨切除（p<0.001）。桨式电极再手术一般持续 1.7±0.2 小时，失血 35±5 毫升，而经皮手术持续 1.3±0.2 小时，失血 12.5±2 毫升。尽管桨式电极更换具有侵入性，但与经皮导丝相比，并发症没有差异（p=0.23）。
本研究描述了 SCS 桨式电极更换手术的安全性概况。在这里，我们证明了在移除时更换桨式电极，如果因疤痕组织需要进一步切除椎板，其并发症发生率较低。这验证了在有经验的、专门从事 SCS 的外科医生的指导下，当临床上需要更换桨式电极时，更换桨式电极具有可行性和低风险特征。
