Electrode implant for Spinal Cord Stimulation
DOI:
https://doi.org/10.47924/neurotarget2025480Keywords:
spinal cord stimulation, percutaneous electrodes, paddle electrodes, electrode implantAbstract
Spinal cord stimulation is a well-established technique for the treatment of refractory pain with specific indications. Studies, including randomized controlled trials, have demonstrated superior results with the use of spinal cord stimulation compared to conservative medical management and repeated lumbar surgery for the treatment of chronic pain syndromes, such as failed back surgery syndrome.
Spinal cord stimulation systems can use percutaneous or paddle electrodes. Percutaneous electrodes have the advantage of being implantable by interventional physicians or anesthesiologists, which is why they are more commonly used, while paddle electrodes require surgical implantation by laminotomy or laminectomy performed by a surgeon. Both types of electrodes have advantages and disadvantages.
In this article, we'll discuss preoperative considerations and the implantation technique for paddle electrodes for spinal cord stimulation, as well as the risks, benefits, and surgical considerations that must be taken into account to achieve a successful outcome, following the NACC recommendations.
Metrics
References
Shealy CN, Mortimer JT, Reswick JB.Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg 1967;46:489-491.
Kumar K, Taylor RS, Jacques L et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain 2007;132:179-188.
North RB, Kidd DH, Farrokhi F, Piantadosi SA. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery 2005;56:98-106.
North RB, Lanning A, Hessels R, Cutchis PN. Spinal cord stimulation with percutaneous and plate electrodes: side effects and quantitative comparisons. Neurosurg Focus 1997;2:e3.
Villavicencio AT, Leveque JC, Rubin L, Bulsara K, Gorecki JP. Laminectomy versus percutaneous electrode placement for spinal cord stimulation. Neurosurgery 2000;46:399-405.
North RB, Kidd DH, Olin JC, Sieracki JM. Spinal cord stimulation electrode design: prospective, randomized, controlled trial comparing percutaneous and laminectomy electrodes-part I: technical outcomes. Neurosurgery 2002;51:381-389.
North RB, Kidd DH, Petrucci L, Dorsi MJ. Spinal cord stimulation electrode design: a prospective, randomized, controlled trial comparing percutaneous with laminectomy electrodes: part II-clinical outcomes. Neurosurgery 2005;57:990-996.
Taghva A, Karst E, Underwood P. Clinical Paresthesia Atlas Illustrates Likelihood of Coverage Based on Spinal Cord Stimulator Electrode Location. Neuromodulation. 2017;20(6):582-588. doi:10.1111/ner.12594
Sheldon B, Staudt MD, Williams L, Harland TA, Pilitsis JG. Spinal cord stimulation programming: a crash course. Neurosurg Rev. 2021;44(2):709-720. doi:10.1007/s10143-020-01299-y
American Academy of Orthopaedic Surgeons Patient Safety Committee, Evans RP. Surgical site infection prevention and control: an emerging paradigm. J Bone Joint Surg Am. 2009;91(suppl 6):2-9.
Moucha CS, Clyburn T, Evans RP, Prokuski L. Modifiable risk factors for surgical site infection. J Bone Joint Surg Am. 2011;93:398-404.
Chen P, Hallock KK, Mulvey CL, Berg AS, Cherian VT. The effect of elevated A1C on immediate postoperative complications: a prospective observational study. Clin Diabetes. 2018;36:128-132.
American Diabetes Association. Standards of medical care in diabetes-2013. Diabetes Care. 2013;36(suppl 1):S11-S66.
Dhatariya K, Levy N, Kilvert A, et al. NHS diabetes guideline for the perioperative management of the adult patient with diabetes. Diabet Med. 2012;29:420-433.
Underwood P, Askari R, Hurwitz S, Chamarthi B, Garg R. Preoperative A1C and clinical outcomes in patients with diabetes undergoing major noncardiac surgical procedures. Diabetes Care. 2014;37:611-616.
Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: surgical site infection guidelines, 2016 update. J Am Coll Surg. 2017;224:59-74.
Møller AM, Villebro N, Pedersen T, Tønnesen H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet. 2002;359:114-117.
Sorensen LT, Karlsmark T, Gottrup F. Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg. 2003;238:1-5.
Beer GM, Wallner H. Prevention of seroma after abdominoplasty. Aesthet Surg J. 2010;30:414-417.
Kumar K, Wilson JR, Taylor RS, Gupta S. Complications of spinal cord stimulation, suggestions to improve outcome, and financial impact. J Neurosurg Spine. 2006;5:191-203.
Fletcher N, Sofianos D, Berkes MB, Obremskey WT. Prevention of perioperative infection. J Bone Joint Surg Am. 2007;89:1605-1618.
Bowater RJ, Stirling SA, Lilford RJ. Is antibiotic prophylaxis in surgery a generally effective intervention? Testing a generic hypothesis over a set of meta-analyses. Ann Surg. 2009;249:551-556.
Burke JP. Maximizing appropriate antibiotic prophylaxis for surgical patients: an update from LDS Hospital, Salt Lake City. Clin Infect Dis. 2001;33(suppl 2):S78-S83
Bendel MA, O’Brien T, Hoelzer BC, et al. Spinal cord stimulator related infections: findings from a multicenter retrospective analysis of 2737 implants. Neuromodulation. 2017;20:553-557.
Matar WY, Jafari SM, Restrepo C, Austin M, Purtill JJ, Parvizi J. Preventing infection in total joint arthroplasty. J Bone Joint Surg Am. 2010;92(suppl 2):36-46.
Malhotra NR, Piazza M, Demoor R, et al. Impact of reduced preincision antibiotic infusion time on surgical site infection rates: a retrospective cohort study. Ann Surg. 2020;271:774-780.
Anderson PA, Savage JW, Vaccaro AR, et al. Prevention of surgical site infection in spine surgery. Neurosurgery. 2017;80:S114-S123.
Erman T, Demirhindi H, Göçer AI, Tuna M, Ildan F, Boyar B. Risk factors for surgical site infections in neurosurgery patients with antibiotic prophylaxis. Surg Neurol. 2005;63:107-112.
Sievert DM, Ricks P, Edwards JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol. 2013;34:1-14.
Sukul V, Lynch T, Loftus C. Optimal approaches to skin preparation prior to neurosurgery. US Neurology. 2010;6:14-18.
Guzel A, Ozekinci T, Ozkan U, Celik Y, Ceviz A, Belen D. Evaluation of the skin flora after chlorhexidine and povidone-iodine preparation in neurosurgical practice. Surg Neurol. 2009;71:207-210.
Yasuda T, Hasegawa T, Yamato Y, et al. Optimal timing of preoperative skin preparation with povidone-iodine for spine surgery: a prospective, randomized controlled study. Asian Spine J. 2015;9:423-426.
Szlachta-McGinn A, Mei J, Tabsh K, Afshar Y. Transverse versus vertical skin incision for planned cesarean hysterectomy: does it matter? BMC Pregnancy Childbirth. 2020;20:65.
Deer TR, Provenzano DA, Hanes M, et al. The Neurostimulation Appropriateness Consensus Committee (NACC) recommendations for infection prevention and management. Neuromodulation. 2017;20:31-50. https://doi.org/10.1111/ner .12565.
Levy R, Henderson J, Slavin K, et al. Incidence and avoidance of neurologic complications with paddle type spinal cord stimulation leads. Neuromodulation. 2011;14: 412-422. https://doi.org/10.1111/j.1525-1403.2011.00395.x.
Deer TR, Mekhail N, Provenzano D, et al. The appropriate use of neurostimulation: avoidance and treatment of complications of neurostimulation therapies for the treatment of chronic pain. Neuromodulation Appropriateness Consensus Committee. Neuromodula-tion. 2014;17:571-597 [discussion: 597-578].
Gazelka HM, Freeman ED, Hooten WM, et al. Incidence of clinically significant percutaneous spinal cord stimulator lead migration. Neuromodulation. 2015;18: 123-125 [discussion: 125].
Mekhail NA, Mathews M, Nageeb F, Guirguis M, Mekhail MN, Cheng J. Retrospective review of 707 cases of spinal cord stimulation: indications and complications. Pain Pract. 2011;11:148-153.
Justiz 3rd R, Bentley I. A case series review of spinal cord stimulation migration rates with a novel fixation device. Neuromodulation. 2014;17:37-40.
Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152:784-791.
World Health Organization. Global guidelines for the prevention of surgical site infection. Accessed January 6, 2021. https://apps.who.int/iris/bitstream/handle/10665/250680/9789241549882-eng.pdf?sequence=8
Hochberg J, Meyer KM, Marion MD. Suture choice and other methods of skin closure. Surg Clin North Am. 2009;89:627-641.
Ahmed I, Boulton AJ, Rizvi S, et al. The use of triclosan-coated sutures to prevent surgical site infections: a systematic review and meta-analysis of the literature. BMJ Open. 2019;9, e029727.
Azmat CE, Council M. Wound closure techniques. Accessed May 20, 2020. http://www.ncbi.nlm.nih.gov/books/NBK470598/
Chan AK, Winkler EA, Jacques L. Rate of perioperative neurological complications after surgery for cervical spinal cord stimulation. J Neurosurg Spine. 2016;25:31-38
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20:250–278.
Deer TR, Stewart CD. Complications of spinal cord stimulation: identification, treatment, and prevention. Pain Med. 2008;9(suppl 1):S93–S101.
Follett KA, Boortz-Marx RL, Drake JM, et al. Prevention and management of intrathecal drug delivery and spinal cord stimulation system infections. Anesthesiology. 2004;100:1582-1594. https://doi.org/10.1097/00000542-200406000-00034.
Yusuf E, Bamps S, Ursi JP, et al. Characteristics of infections associated with a spinal cord stimulator system. J Infect. 2016;73:515-517. https://doi.org/10.1016/j .jinf.2016.08.012.
Franzini A, Ferroli P, Marras C, Broggi G. Huge epidural hematoma after surgery for spinal cord stimulation. Acta Neurochir (Wien). 2005;147:565-567.
Pahapill PA, Lownie SP. Conservative treatment of acute spontaneous spinal epidural hematoma. Can J Neurol Sci. 1998;25:159-163.
Brown MW, Yilmaz TS, Kasper EM. Iatrogenic spinal hematoma as a complication of lumbar puncture: what is the risk and best management plan? Surg Neurol Int. 2016;7(suppl 22):S581-S589.
Labaran L, Jain N, Puvanesarajah V, Jain A, Buchholz AL, Hassanzadeh H. A retrospective database review of the indications, complications, and incidence of subsequent spine surgery in 12,297 spinal cord stimulator patients. Neuromodulation. 2020;23:634-638.
Wernick B, Nahimiak P, Stawicki SP. Impaired wound healing. Accessed December 15, 2020. https://www.ncbi.nlm.nih.gov/books/NBK482254/
Ismael H, Horst M, Farooq M, Jordon J, Patton JH, Rubinfeld IS. Adverse effects of preoperative steroid use on surgical outcomes. Am J Surg. 2011;201:305–308.
Zhu J, Gutman G, Collins GJ, Colonna JA. Review of surgical techniques in spinal cord stimulator implantation to decrease the post-operative infection rate. J Spine. 2014;4:1–12. https://doi.org/10.4172/2165-7939.1000202.
Mehta SK, Breitbart EA, Berberian WS, Liporace FA, Lin SS. Bone and wound healing in the diabetic patient. Foot Ankle Clin. 2010;15:411-437.
Stechmiller JK. Understanding the role of nutrition and wound healing. Nutr Clin Pract. 2010;25:61-68. https://doi.org/10.1177/0884533609358997.
Silverstein P. Smoking and wound healing. Am J Med. 1992;93:22S-24S.
Deer TR, Russo M, Grider J, et al. The Neurostimulation Appropriateness Consensus Committee (NACC): recommendations for therapy salvage and persistent outcome optimization. Neuromodulation. In press.
Babu R, Hazzard MA, Huang KT, et al. Outcomes of percutaneous and paddle lead implantation for spinal cord stimulation: a comparative analysis of complications, reoperation rates, and health-care costs. Neuromodula-tion. 2013;16(5):418-427. doi:10.1111/ner.12065
Rosenow JM, Stanton-Hicks M, Rezai AR, Henderson JM.Failure modes of spinal cord stimulation hardware.J Neurosurg Spine 2006;5:183-190
North RB, Lanning A, Hessels R, Cutchis PN. Spinal cord stimulation with percutaneous and plate electrodes: side effects and quantitative comparisons. Neurosurg Focus. 1997;2:e3.
Villavicencio AT, Leveque JC, Rubin L, Bulsara K, Gorecki JP. Laminectomy versus percutaneous electrode placement for spinal cord stimulation. Neurosurgery. 2000;46:399-405.
North RB, Kidd DH, Olin JC, Sieracki JM. Spinal cord stimulation electrode design: prospective, randomized, controlled trial comparing percutaneous and laminectomy electrodes-part I: technical outcomes. Neurosurgery. 2002;51:381-389.
North RB, Kidd DH, Petrucci L, Dorsi MJ. Spinal cord stimulation electrode design: a prospective, randomized, controlled trial comparing percutaneous with laminectomy electrodes: part II-clinical outcomes. Neurosurgery. 2005;57:990-996.
Kumar K, Wilson JR. Factors affecting spinal cord stimulation outcome in chronic benign pain with suggestions to improve success rate. Acta Neurochir Suppl. 2007;97:91-99.
North RB, Ewend MG, Lawton MT, Piantadosi S. Spinal cord stimulation for chronic, intractable pain: superiority of “multi-channel” devices. Pain. 1991;44:119-130.
Barolat G. Experience with 509 plate electrodes implanted epidurally from C1 to L1. Stereotact Funct Neurosurg. 1993;61:60-79.
Cameron T. Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: a 20-year literature review. J Neurosurg. 2004;100:254-267.
Turner JA, Loeser JD, Deyo RA, Sanders SB. Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome: a systematic review of effectiveness and complications. Pain. 2004;108:137-147.
Kim DD,Vakharyia R,Kroll HR,Shuster A.Rates of lead migration and stimulation loss in spinal cord stimulation: a retrospective comparison of laminotomy versus percutaneous implantation. Pain Physician 2011;14:513-524.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Facundo Villamil, Fabián César Piedimonte
This work is licensed under a Creative Commons Attribution 4.0 International License.
The article is distributed under the Creative Commons Attribution 4.0 License. Unless otherwise stated, associated published material is distributed under the same licence.
