Assessment of Pain Relief and Spinal Instability in Patients Undergoing Paddle Spinal Cord Stimulation for Failed Back Surgery Syndrome

The use of paddle spinal cord stimulators has emerged as a promising treatment option for patients suffering from failed back surgery syndrome (FBSS). However, the surgical approach required to implant these devices can pose risks, including iatrogenic vertebral instability. In this study, we aimed to assess the degree of instability and pain level in patients undergoing paddle spinal cord stimulation through laminectomy or laminotomy with midline structure preservation.

Our investigation included 19 patients with FBSS who underwent paddle spinal cord stimulation using a paddle lead system from Abbott. Twelve patients underwent laminectomy, while seven patients underwent uni- or bilateral interlaminotomy with supraspinous ligament preservation. We performed static and dynamic X-rays after two months to evaluate any radiological signs of postoperative iatrogenic vertebral instability.

Interestingly, we did not observe any radiological signs of postoperative iatrogenic vertebral instability in our patients. However, local pain was higher and recovery time was longer in patients who underwent laminectomy compared to those who underwent laminotomy with midline structure preservation. Notably, no intraoperative complications occurred during the surgical procedure.

The implantation technique allowed for the successful placement of paddle leads in all cases, enabling effective treatment for our patients' chronic back pain. We evaluated postoperative local pain at 15, 30, and 60 days after surgery to assess the effectiveness of the treatment.

In contrast to previous studies that have shown a higher risk of iatrogenic instability when performing laminectomy, our results suggest that preserving midline ligamentous structures during laminotomy can help prevent this complication. This finding is consistent with clinical and experimental data highlighting the importance of minimizing resection of inferior and superior lamina while preserving the midline ligamentous structures.

Paddle spinal cord stimulation has been shown to be a more effective treatment option for patients suffering from FBSS compared to percutaneous catheters. Our preliminary results suggest that this approach can provide significant pain relief, even in patients who have undergone multiple previous surgeries.

In conclusion, our study highlights the importance of preserving midline ligamentous structures during laminotomy to prevent iatrogenic vertebral instability when implanting paddle spinal cord stimulators for FBSS. These findings support the use of paddle leads as a safe and effective treatment option for this patient population. Further research is needed to confirm these preliminary results and explore the long-term benefits of paddle spinal cord stimulation in patients with FBSS.

Paddle spinal cord stimulator abbott