Maldonado-Naranjo AL, Frizon LA, Sabharwal NC, et al. Four year follow-up of dual electrode spinal cord stimulation for chronic pain. Spinal cord stimulation: the clinical application of new technology. Six weeks later, the patient reported excellent relief of her back pain and had successfully weaned off all opioid therapy. The IPG was replaced with the latest technology and implanted into the original pocket. The leads were then anchored to the T12 spinous process and tunneled to the implantable pulse generator (IPG) site (Figs. The original incision was extended cephalad along with further dissection, hemilaminotomies were performed to the right of the T9 and T10 vertebrae, and extensive epidural scar tissue was resected two leads were then driven to the middle and top of the T8 and T9 vertebrae with double coverage of the T9–T10 disk space for targeted therapy. Two separate 8-contact cylindrical leads were then placed under direct visualization without needle guidance via the T10–T11 incision site into the epidural space. Years later, the patient presented with worsened pain and loss of therapy, with subsequent decision to remove the original paddle lead and place cylindrical leads compatible with her current generator system.įluoroscopy was utilized to identify the paddle lead, which was removed intact without complication with careful posterior surgical dissection. This case describes a 58-year-old woman with a history multiple lower back surgeries who was originally implanted with an 8-electrode (4 × 2) paddle lead via a T11 laminectomy spanning the T10–T11 vertebrae. Typically, if a paddle lead is no longer effective, a revision surgery is performed to place a new paddle, which may increase the risks of abandonment technology and perioperative complications, increased treatment costs, and potential worsening of the patient’s overall pain level. There is debate on how to proceed with treatment in patients with previous paddle lead spinal cord stimulation (SCS) who are no longer reporting adequate pain relief, thought to be due to extensive scar tissue that can form over the paddle. Traditionally, spinal cord neuromodulation included paddle lead placement however, recent technological innovations have led to less invasive techniques.