Axial neck pain – retrograde paddle

This 47 year old man had previous thoracic implant for low back and leg pain with great success.  He presented with worsening neck pain, persistent after an anterior cervical fusion by outside physician.  He had a trial by his pain physician with good relief at top of the midline electrode.

cervical

To optimize cervical coverage and reduce migration I placed dual Exclaim leads by St. Jude in a retrograde fashion.  The leads tunnel from the epidural space at the Occipital-cervical membrane under the ring of C1 and docked halfway under C2.  This lead contains six exclamation point style contacts for a total of 12 individual contacts.  However, each row of dots is wired together to function as a single contact for a total of eight functional electrodes.

retrogradedual

My experience with this technique is that it provides excellent side to side coverage and can often cover the C2 nerve root as it emerges from the cord.  This can give occipital nerve coverage as well as axial neck coverage.  However, I have had one case of a lead fracturing at the site of entry into the paddle, presumably from too much stress at this point despite placing a strain relief.

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