Minimally-invasive Placement of Spinal Cord Stimulator Paddle Electrodes is Associated with Improved Perioperative and Long-term Experience among Neuropathic Pain Patients

STUDY DESIGN: Prospective, observational cohort study. OBJECTIVE: This study compared in-hospital and long-term outcomes among spinal cord stimulation (SCS) patients undergoing paddle insertion by open or minimally invasive surgery (MIS) approaches. SUMMARY OF BACKGROUND DATA: Patients with treatment-refractory extremity neuropathic pain may benefit from SCS. Conventional placement of surgical paddles for an external neurostimulation trial is through open laminectomy, but MIS techniques may offer advantages. METHODS: Twenty SCS patients were prospectively assessed. Open patients underwent caudal thoracic laminectomy for multicolumnar electrode paddle placement. MIS patients underwent paddle placement through interlaminar flavectomy using tubular retractors. Demographic data included age, sex, underlying diagnosis, and preoperative visual analog scale (VAS) extremity scores. Intraoperative data included operative duration, blood loss, and number of device passages to achieve final position. Perioperative data included VAS back pain scores; trial data included time-to-trial and time-to-decision. Postoperative data included 1 month VAS back pain scores and 1 year follow-up device complications. RESULTS: No demographic differences were observed among surgical cohorts. MIS procedures had shorter operative duration (P = 0.03), less blood loss (P < 0.001), and similar median number of device passages (2 vs 1.5, P = 0.71). MIS patients reported less perioperative surgical back pain (P < 0.05). External neurostimulation trials began sooner among MIS patients who also made sooner decision whether to implant the SCS device (2.8 ± 1.4 vs 4.3 ± 1.0 days, P = 0.013). Similar 1 month back pain scores were reported between surgical cohorts (P = 0.08). CONCLUSION: MIS techniques for SCS surgical paddle implantation is associated with less perioperative morbidity and surgical site back pain, shorter external neurostimulator trial duration, and long-term device stability benefits. LEVEL OF EVIDENCE: 2.