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.

latermig2

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

latmigrpost

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).