Ahead of Print: EMG for Placing SCS Leads
Background: Placement of spinal cord stimulating paddle leads has traditionally been performed using local anesthesia with intravenous sedation to allow for intraoperative confirmation of appropriate placement. It may be difficult to maintain appropriate sedation in certain patients due to medical comorbidities. Furthermore, patients undergoing lead revision frequently have extensive epidural scarring, requiring multi-level laminectomies to place the electrode appropriately.
Objective: We report our technique of neurophysiologic monitoring which allows these procedures to be performed under general anesthesia.
Methods: Data from 78 patients who underwent electromyography (EMG) during laminectomy for paddle lead placement were retrospectively reviewed. 70 patients presented for first-time permanent system placement following a successful trial, and 8 were referred for revision or replacement of previously functioning systems. Surgeries were performed under general anesthesia, with fluoroscopic guidance. EMG was used to help define the physiologic midline of the spinal cord and guide appropriate lead placement. Somatosensory evoked potentials (SSEP) were used as an adjunct to minimize the possibility of neural injury.