Lateral paddle migration – salvaged with percutaneous lead

This 59 year old woman with midthoracic dextroscoliosis underwent a paddle placement by outside physician at the target level after a successful trial.  Several weeks post-op the patient experienced loss of coverage on the left side (inside of curve).  This is a common complication in placement of the paddle.  Leads tend to migrate to the outside of the curve so implantation should be performed on the medial side.  Furthermore there is significant rotatory deformity as you can see from the spinous process position.

lateralmigration

While I love the Artisan paddle, this lateral migration is more common given its narrow width.

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As you can see, this paddle placement violates my preference for anchoring immediately below the paddle at the crotch of the tails.

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I was able to salvage this implant with a percutaneous lead placed on the inside of the curve in about 15 minutes (much easier than a paddle revision).

Dual paddle case with splitter

This 42 year old gentleman had two distinct areas of pain and had successful trials with octrodes placed at T1 and T8. dualpaddle-pain

He underwent dual paddle placements at the approriate level.  We used a wide space splitter to connect each pair of tails to a single port on the IPG.  dualpaddle  Splitter1

The IPG pocket gets crowded with two splitters feeding into the can.  I recommend creating a dual layer pocket with the deepest layer for the splitters and the superficial pocket for the IPG.  This keeps the leads coiled nicely below.

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Trolling the sweet spot – back pain without leg pain

This is a 58 year old man who had a L4-5 fusion for mobile spondylolisthesis with marked improvement in his low back and leg pain, but had persistent midback pain.

 

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Mid back coverage without getting legs is somewhat difficult.  I typically start at T6-7 and retreat the lead, but in this case the coverage was lower than expected.

Trolling the sweet spot

The 16 contact Infinion™ by Boston Scientific allows you to troll the spinal cord after implant to better isolate the sweet spot.  As with all of my cases, I have my rep mark the sweet spot for final implantation.

splitter

The downside is somewhat awkward splitter that divides the 16 contact lead into two octrodes that fit in an external IPG.  As shown here, the Infinion™ trial lead only comes in 50cm lengths.  I prefer the longer 70cm length to get the splitter off the midline and over the flank for a more comfortable trial.  You have to use a 70cm permanent lead as a trial to do this.

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As a trialing lead this gives you the optimum level for permanent implantation.