The postoperative X-rays showed the correct position of the plates.Īfter the epidural trial, we removed 1 Hinged 4 + 4 because ineffective and 1 Specify 5 + 6 + 5 because of an infection. We did not have any intraoperative problem during surgery technique related.Īll patients stood up on the same day of surgery and were discharged within 48-72 hours without neurological deficits or wound problems. In one case a unilateral approach was converted to a bilateral to achieve a median position of the electrode. In all cases the paddle leads (3 Hinged 4 + 4 and 4 Specify 5 + 6 + 5) were implanted through uni- or bilateral interlaminotomy with complete preservation of the supraspinous ligament. The clinical efficacy of SCS in terms of pain relief is not debated. We presented our preliminary findings and discussed advantages and limitations of this microinvasive technique. Aim of the study was to assess if a minimally invasive approach may allow reducing spinal instability and local pain after surgery. In our Neurosurgical Division SCS for FBSS was performed in 19 patients through a uni- or bilateral laminotomy or a partial laminectomy. In contrast, a bilateral laminotomy with midline structures preservation may ensure the spinal stability and this is confirmed by biomechanical experimental tests carried out on animal models. The paddle lead is usually implanted through a bilateral flavectomy and partial laminectomy with midline ligamentous structures resection. A systematic review of the English language literature from 1996 to 2008 evaluating the effectiveness of SCS in relieving chronic pain in FBSS indicated the evidence to be level II-1 or II-2. As a matter of fact, several authors reported better coverage of pain and clinical outcome with fewer adverse effects. Insulated arrays implanted via laminectomy demonstrated performance advantages, in comparison with percutaneous electrodes. Spinal cord stimulation (SCS) is an effective therapy in chronic intractable pain of failed back surgery syndrome (FBSS) with pain relief rates between 50% and 75% in long-term follow-up. Keywords: Failed back surgery syndrome, laminotomy, paddle lead, spinal cord stimulation minimally invasive technique Further studies are needed to confirm our preliminary results. Nevertheless, two patients who underwent laminectomy showed persistence of local pain after 2 months probably due to pathologic compensatory stability provided by the paraspinal musculature.Ĭonclusions:The laminotomy is a minimally invasive approach that ensures rapid recovery after surgery, spinal functional integrity, and complete reversibility. We did not observe radiological signs of postoperative iatrogenic vertebral instability. Local pain was higher and recovery time was longer in patients with laminectomy. No intraoperative complications occurred. ![]() Results:The techniques allowed implanting the paddle leads in all cases. Static and dynamic X-rays were performed after 2 months. Postoperative local pain was evaluated at 15, 30, and 60 days. Methods:Nineteen patients with FBSS underwent SCS, 12 through laminectomy and 7 through uni- or bilateral interlaminotomy with supraspinous ligament preservation. ![]() The surgical technique is described and our preliminary results are discussed. Aim of the study was to assess degree of instability and pain level in patients operated for SCS through laminectomy or laminotomy with midline structures integrity. In contrast, clinical and experimental data showed that a laminotomy performed through flavectomy and minimal resection of inferior and superior lamina with preservation of the midline ligamentous structures allowed to prevent iatrogenic instability. ![]() ![]() A laminectomy is generally required to implant the paddles, but the surgical approach may lead to iatrogenic spinal instability in flexion. Background:Pain relief obtained with spinal cord stimulation (SCS) in failed back surgery syndrome (FBSS) has been shown to be more effective with paddle leads than with percutaneous catheters.
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