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).

Retained percutaneous lead – fractured

Retained lead Lat1 Retained lead Lat2  Retained lead AP1

This case came from a very experienced trialing physician who could not remove the previously placed St. Jude trial lead.  He called me when the lead broke three inches from skin insertion after attempting to pull it out in the post-op clinic.  He tried numerous positions with the patient flexing and extending, but the lead would not withdraw.  I instructed him to pull the lead as much as he could then thorough prep the insertion point and cut the lead with sterile scissors.  Then the presumably sterile remainder would withdraw into the wound and the tract would close.  The patient was kept on antibiotics and taken to the operating room on week later for retrieval and permanent implantation.

Retained lead AP2

The lead was harvested from a skin incision over the remaining tail and withdrawn.  The lead was pinched in the lateral portion of the interlaminar space adjacent to the facet.  A Penta paddle was placed at the previous target level and patient tolerated the procedure well.

retained lead2 penta