Letter to the Editor, Regarding “Technique for Steering Spinal Cord Stimulator Electrode”
To the Editor:
We read with interest the article by MacDonald JD, Fisher. The authors are to be congratulated on their novel technique for intraoperative steering of a paddle electrode in 15 patients.
They describe tying a 3-0 Vicryl knot in the tip of a paddle stove electrode and then using a malleable suture retrievable snare to grasp the knot. The electrode tip and the malleable snare are then introduced into the epidural space, whereby the electrode tip is pulled into position; the malleable snare is then removed.
The authors note that fluoroscopy was used to ensure placement of the electrode in the desired initial location. We wonder whether the fluoroscopy was anteroposterior and/or lateral while introducing the malleable retriever and paddle electrode into the epidural space because the introduction of a flexible paddle electrode along with a semirigid malleable retriever would seem to pose a risk of direct or indirect spinal cord compression. We also wonder whether the suture that remains in the paddle electrode tip was found to cause any problems in terms of scarring or difficulty in removing the electrode at a later date.
Although the technique described by the authors appears useful, we would urge caution anytime a semirigid malleable receiver and a flexible paddle electrode are introduced into the epidural space. Because of the potential for increased scarring or difficulty in electrode removal, we also think knowledge about the outcomes of subsequent revision surgeries is important.
Gilbert, John W.; Herder, Stephanie; Mick, Gregory E.; Windsor, Robert E.
1. MacDonald JD, Fisher KJ. Technique for steering spinal cord stimulator electrode. Neurosurgery. 2011;69(1 suppl):ons83–ons86; discussion ons86-ons87