Endoscopic Implantation of Spinal Cord Stimulators: Technical Note and Comparison With Standard Techniques

BACKGROUND AND OBJECTIVES: Spinal cord stimulation (SCS) is an effective neuromodulatory tool for various chronic pain conditions. Traditionally, the SCS procedure involved an open approach with laminotomy for paddle implants. The minimally invasive percutaneous lead placement has largely replaced open paddles. However, percutaneous leads are prone to migration and may be unfeasible in patients with preexisting epidural scarring, necessitating open paddle placement. An endoscopic approach to the spine would offer reduced morbidity with the stimulation benefits and security of open paddle. We therefore aimed to develop this technique. METHODS: An endoscopic method for SCS paddle implantation was developed initially in a cadaveric laboratory. We tested an anterograde and retrograde method of implantation. The retrograde method of implantation was chosen and subsequently used in 5 patients. A retrospective review of electronic medical records was subsequently undertaken to compare these endoscopic cases with consecutive concurrent open and percutaneous cases. RESULTS: The retrograde method of implantation was chosen because of reduced bony and soft tissue dissection required. In addition, more secure implantation was possible with this approach. We describe the endoscopic technique in detail. Five endoscopic cases were compared with 20 percutaneous and 13 open cases. Postoperative analgesia requirements for the endoscopic and percutaneous cases were similar, and both were significantly lower than for open cases ( P < .001). Operative time was expectantly longer for endoscopic cases. Same-day programming was possible with endoscopic cases, and with modified anesthetic and programming protocols, same-day discharge was possible for our last endoscopic case. With 6-month follow-up, we did not have any wound-related problems or hardware migration in these cases. CONCLUSION: Our findings indicate that endoscopic SCS implantation is a safe and feasible option that combines key advantages of both open and percutaneous standard approaches for SCS implantation.