Department of Neurosurgery, Albany Medical College, Albany, NY, USA.
Department of Neurosurgery, Beaumont Neuroscience Center, Royal Oak, MI, USA.
Neuromodulation. 2024 Jan;27(1):183-187. doi: 10.1016/j.neurom.2023.07.011. Epub 2023 Aug 24.
Placement of a standard paddle lead for spinal cord stimulation (SCS) requires a laminotomy for positioning of the lead within the epidural space. During initial placement, an additional laminotomy or laminectomy, termed a "skip" laminotomy, may be necessary at a higher level to pass the lead to the appropriate midline position. Patient and radiographic factors that predict the need for a skip laminotomy have yet to be identified.
Participants who underwent SCS paddle placement at Albany Medical Center between 2016 and 2017 were identified. Operative reports were reviewed to identify the paddle type, level of initial laminotomy, target level, and skip laminotomy level. Preoperative thoracic magnetic resonance images (MRIs) were reviewed, and spinal canal diameter, interpedicular distance, and dorsal cerebral spinal fluid thickness were measured for each participant when available.
A total of 106 participants underwent thoracic SCS placement. Of these, 97 had thoracic MRIs available for review. Thirty-eight participants required a skip laminotomy for placement of the paddle compared with 68 participants who did not. There was no significant difference in demographic features including age, sex, body mass index, and surgical history. Univariate analyses that suggested trends were selected for further analysis using binary logistic regression. Level of initial laminotomy (odds ratio [OR] = 1.51, p = 0.028), spinal canal diameter (OR = 0.71, p = 0.015), and dorsal cerebrospinal fluid thickness (OR = 0.61, p = 0.011) were correlated with skip laminotomy. Target level (OR = 1.27, p = 0.138) and time from trial (1.01, p = 0.117) suggested potential association. The multivariate regression was statistically significant, X(10) = 28.02, p = 0.002. The model explained 38.3% of the variance (Nagelkerke R) and predicted skip laminectomy correctly in 73.3% of cases. However, for the multivariate regression, only a decrease in spinal canal diameter (OR = 0.59, p = 0.041) was associated with a greater odds of skip laminotomy.
This study aims to characterize the patient and radiographic factors that may predict the need to perform a skip laminotomy during the initial placement of SCS paddles. Here, we show that radiographic and anatomic variables, primarily spinal canal diameter, play an important role in predicting the need for a skip laminotomy. Furthermore, we suggest that target level for placement and level of initial laminotomy also may contribute. Further investigation of the predictive factors for performing a skip laminotomy would help optimize surgical planning and preoperative patient selection and counseling.
脊髓刺激 (SCS) 的标准桨状导联的放置需要进行椎板切开术，以便将导联放置在硬膜外间隙内。在初始放置时，为了将导联传递到适当的中线位置，可能需要在更高的水平进行额外的椎板切开术或椎板切除术，称为“跳过”椎板切开术。预测需要进行“跳过”椎板切开术的患者和影像学因素尚未确定。
确定了 2016 年至 2017 年期间在奥尔巴尼医疗中心接受 SCS 桨状导联放置的参与者。回顾手术报告以确定桨状导联的类型、初始椎板切开术的水平、目标水平和“跳过”椎板切开术的水平。当有术前胸椎磁共振成像 (MRI) 时，回顾了每个参与者的椎管直径、椎间孔距离和背侧脑脊髓液厚度。
共有 106 名参与者接受了胸椎 SCS 放置。其中，97 名参与者有可用的胸椎 MRI 进行审查。与 68 名未接受“跳过”椎板切开术的参与者相比，38 名参与者需要进行“跳过”椎板切开术以放置桨状导联。年龄、性别、体重指数和手术史等人口统计学特征无显著差异。单变量分析表明，初始椎板切开术水平（比值比 [OR] = 1.51，p = 0.028）、椎管直径（OR = 0.71，p = 0.015）和背侧脑脊髓液厚度（OR = 0.61，p = 0.011）与“跳过”椎板切开术相关。目标水平（OR = 1.27，p = 0.138）和试验时间（OR = 1.01，p = 0.117）提示可能存在关联。多元回归具有统计学意义，X(10) = 28.02，p = 0.002。该模型解释了 38.3%的方差（Nagelkerke R），并正确预测了 73.3%的“跳过”椎板切开术病例。然而，对于多元回归，只有椎管直径的减小（OR = 0.59，p = 0.041）与“跳过”椎板切开术的可能性更大相关。
本研究旨在描述可能预测在初始放置 SCS 桨状导联时需要进行“跳过”椎板切开术的患者和影像学因素。在这里，我们表明，影像学和解剖学变量，主要是椎管直径，在预测“跳过”椎板切开术的需求方面起着重要作用。此外，我们建议目标放置水平和初始椎板切开术水平也可能有贡献。进一步研究“跳过”椎板切开术的预测因素将有助于优化手术计划和术前患者选择和咨询。
