Implantation of surgical electrodes for spinal cord stimulation: classical midline laminotomy technique versus minimal invasive unilateral technique combined with spinal anaesthesia

Summary

The implantation of surgical electrodes is still considered painful and invasive. Is there a possibility to diminish these disadvantages by applying a less invasive implantation procedure at the thoracic level and eventually combine this approach with a less stressful paresthesia coverage testing in the intraoperatively awake patient? In this paper, the postoperative outcome of two surgical techniques to insert surgical plate electrodes at the thoracic level is compared. In a prospective single blind study, the Classical Midline Laminotomy technique (CML) is opposed to a Minimal Invasive unilateral Technique (MIT). There were ten patients in each group, allocated at random. Postoperative pain was measured by an unbiased third party on the first and third day after electrode implantation using the Visual Analogue Scale (VAS) score. Length of hospital stay was compared in both groups. Patients were asked if they would, if necessary, undergo the same procedure again. In all comparisons, the MIT group scored significantly better. It can be concluded that a minimal invasive unilateral technique has some advantages over midline laminotomy. Refinements of the implantation procedure are discussed, i.e minimal invasive unilateral technique in combination with spinal (intrathecal) anaesthesia, surgical hints and the technique’s use in revision surgery for migrated electrodes.