Abandoned SCS paddles

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NJPAIN

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In my new role I am seeing patients with FBSS and t9-t11 abandoned SCS paddles from 10-15 years ago. The overwhelming majority are Medtronic. With the changes in technology in that time period, I feel that many would benefit from another trial. Can’t say that I have ever been faced with this situation previously as explants were typically perc so everything was removed. Now, the IPGs are removed with the paddles remaining.

I’m interested to know the thoughts of others regarding the feasibility and experience of retrialing this type of patient.
 
I have a patient whose paddle migrated upwards somehow, so technically she would be a candidate for new leads. But she’s pretty soured on stim because of her experience.
 
BobBarker said:
Fluoroscopic exam to find lead tip, determine if intact. Expose lead tip through as small an incision as possible. Connect to extension and bury. Externalize extension end and connect to EPG. Trial.
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Agreed. See if the paddle has active viable electrodes and trial with HF and LF options. Removing the paddle and replacing it will take a very patient neurosurgeon, and the nightmare revision may result in 1-2 erratically placed perc leads by the surgeon.
 
I have only seen once someone scoot a trial lead around a paddle and get reasonable positioning in about 8 attempts. The one time it worked was the first time and it was in fellowship.
 
BobBarker said:
I have only seen once someone scoot a trial lead around a paddle and get reasonable positioning in about 8 attempts. The one time it worked was the first time and it was in fellowship.
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How is there enough room / no scar around the paddle! Probably couldn’t even get a thoracic mri preop as the leads were abandoned
 
I was hoping I was wrong in concluding that this was not a salvageable situation. Unfortunate. I’ve seen 8 or 9 of these in the last 3 months. All placed for predominant LBP and all implanted with a system without the technology to have a shot at covering the lower back. Now they all have abandoned paddles and the SCS door has been closed. I don’t have much interest in “fishing” out the leads to retrial using the existing paddle.

I guess I’ll have to decide how much I believe Chapman’s reports of control of LBP with T12 DRG stimulation.
 
NJPAIN said:
In my new role I am seeing patients with FBSS and t9-t11 abandoned SCS paddles from 10-15 years ago. The overwhelming majority are Medtronic. With the changes in technology in that time period, I feel that many would benefit from another trial. Can’t say that I have ever been faced with this situation previously as explants were typically perc so everything was removed. Now, the IPGs are removed with the paddles remaining.

I’m interested to know the thoughts of others regarding the feasibility and experience of retrialing this type of patient.
Click to expand...
If leads from paddle are intact try hooking it up to a new generation battery. I would have tried putting a lead below the paddle. I wouldn't go above or adjacent to it due to stenosis concerns.
 
I had an opportunity managing around 5 cases of this situation in the past two years, will have one tomorrow. trial with external extension, caudal stim, and retrial using perc lead, i was lucky and successful in most cases.
 
chris tian said:
I had an opportunity managing around 5 cases of this situation in the past two years, will have one tomorrow. trial with external extension, caudal stim, and retrial using perc lead, i was lucky and successful in most cases.
Click to expand...
Caudal stim?
 
In my opinion if stim was the only option I would trial DRG at T12
 
I regretted brought up caudal stim, no argument with any of you, l learnt this from pain fellowship training, there was some paper out there. I am aware patients followed up over 10 years, the sim is still working.
 
Never done this. In my limited experience people that have stims that don’t work well for them either want it explanted, or let the IPG die and won’t consider another trail of stimulation.
 
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