Spinal Cord Stimulation: Placement of Surgical Leads via Laminotomy: Techniques and Benefits

Spinal cord stimulation provides a nondestructive and adjustable method of pain relief for several neuropathic pain syndromes, including failed back surgery syndrome and complex regional pain syndrome. Optimizing pain relief in these patients relies on proper patient selection, understanding of the implanted hardware, and proper preoperative planning and intraoperative technique. Compared with percutaneously implanted cylindrical leads, paddle electrodes that are surgically implanted offer improved paresthesia and pain coverage, power consumption, and fewer needs for revision due to lead migration at the cost of additional anesthetic needs and a more invasive procedure. Several considerations must be made in the perioperative setting to minimize complications associated with surgical implantation and maximize patient satisfaction. This chapter will discuss common indications, pitfalls to avoid, and basic surgical technique for implantation of surgical paddle electrodes for spinal cord stimulation.