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Cervical Laminotomy necessary for SCS

kcrozkkcroz Posts: 33
edited 06/11/2012 - 8:25 AM in Pain Management
I had an appointment with a N/S who will implant a cervical SCS. However he wants to use paddle leads and will do a laminotomy at the top of my neck to insert leads. He said this procedure is very painful and I should expect to spent two to three days in the hospital. He also said I would not be awake for the surgery. To say I am apprehensive would be an understatement! I had fusion on C5/6 & C6/7 last year but that was done in the front of my neck. I can't imagine what it would feel like to cut the muscles in the back of my neck. Currently my pain is pretty well controlled with 80mg of Oxycontin ER three times a day. I work from home so when the pain is too much I can take Soma and go to bed. I don't know how long my P/M will continue to prescribe this amount without having the SCS. I don't know how long it will be before my tolerance builds and this dosage would not be adequate. I realize the paddle leads would be better in the long run in regards to any migration. Has anyone had this procedure?

Karen
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Comments

  • While spinal cord stimulation has commonly been carried out using percutaneous leads, these devices have limitations in cervical implants due to problems with positional stimulation and lead migration. Paddle leads, by virtue of their design, are more stable in their apposition to the neural elements; however, mid and lower cervical insertions have been associated with both acute and subacute spinal cord injuries. These complications are likely related to limitations in canal diameter, as paddle leads occupy a greater volume than percutaneous leads. At C1-C2, the space around the spinal cord is more generous, and thus allows greater room for insertion of leads. We report a series of patients treated with a technique for the implantation of a C1-C2 paddle electrode that capitalizes on this anatomy while still meeting the need for paresthetic overlap in patients with upper extremity pain syndromes. While the technique is not novel, it has not yet been popularized (1). This paper is presented to increase implanters' awareness of the method, its safety and utility. Twenty consecutive patients with neuropathic pain syndromes of the upper extremity were implanted using this technique. Surgical implantation of leads was done under a general anesthetic. An upper cervical incision was used, and after performing minimal laminotomies at C1 and C2, the lead was passed rostro-caudally under direct visualization beneath the lamina. Paresthetic overlap of pain segments was achieved in all but one patient. Pre and postoperative VAS scores were compared to evaluate effectiveness of treatment. Eighteen of 20 patients reported a significant benefit from stimulation, with an average of 63 percent reduction in pain scores. The only complication was a malpositioned lead that required reoperation to adjust placement. No patient suffered neurologic sequelae as a result of this procedure. We have found C1-C2 sublaminar insertions of paddle leads to be a safe and effective way of treating neuropathic pain phenomenon involving the upper extremity. To further assess the relative benefit over percutaneous leads, a prospective trial would be required.
  • All I can say is that based on having posterior surgery at C1 and C2 with laminotomies and ganglionectomy, it is definitely painful.

    "C"
  • "C" if you say it is painful, I know I'm in trouble. I say this first of all because you were in the military and secondly given your history. I have an appointment with P/M in January. Hopefully he will not insist on this procedure and will let me continue with my current meds.

    How long was your recovery time? It makes my neck hurt just thinking about cutting through the muscle on the back of my neck!
  • Recovery was shaky because I had what they classified as a minor stroke (either during or shortly after surgery) that damaged my vestibulocochlear nerve and caused nystagmus, vertigo and hearing loss. I was a mess for a few months. The pain from the surgery was bad for a good 3 to 4 weeks. After that it was just uncomfortable.

    Compared to all the posterior lumbar surgeries and open wound healing ... the posterior cervical surgery was 10 times worse. Doable because it was necessary, but it was a bear. They had to go in twice in 8 days, so that may have made it worse than if it was just the one time.

    I lost two muscles on the left side due to denervation from the surgery, so complications from going in at that area can be greater than most realize.

    Have you discussed using percutaneous leads instead of the paddle leads? I get great coverage with 2 percutaneous leads that were inserted through C7-T1 and run upwards. I can stim both shoulders, arms, hands and any finger I wish. It is fairly positional for full coverage, but that is easy to adapt to, and can actually be used as a benefit. The trial leads are far more positional than the permanent leads.

    "C"
  • I am 10 days out from the surgery your talking about. Im still in quite a bit of pain but Ive gotten my pain meds for my neck down to about twice a day. Ive totally stoped the pain meds for my arm. I have CPRS in my right arm and its pretty bad. The SCS has been a god sent. Its wroking beautifully and totally covering the pain. I nor my docs have expected this but its awesome/miracle to say the least. I had a lot of pain just coming out of surgery, I coudlnt move for about a day without someone actually picking me up so I could go to the bathroom. I had to have IV pain meds/muslce relaxers almost hourly for aobut 48 hrs ad then they weaned me down to where I could go home. I spent the first 2 days in the recliner at home and then started to move around. I noticed the more I moved around the better I felt. I feel so much better without all those drugs in my body, I feel free now to go on with my life. They reccomended the paddle leads for me too because during the trial there was alot of movement. Since the surgery I can move my neck and not loose stimulation. The paddle leads are worth it. Im not going to lie its a hard recovery but its worth it. Good luck
  • I was relieved when I was told they would use a precutaneous lead for my shoulder and arm pain. It is far more stable than the trial lead was. I have a single lead and have coverage of BOTH shoulders and arms with the one lead!

    Call me chicken, but the idea of having surgery on my neck to control pain on my shoulder just plain sounded both scary and painful! I had heard that the surgery for paddle leads may be done. I am very happy with my precutaneous lead.

    I do as "C" says also, I use the positional nature of the lead if needed. I just turn my head to get the right sensation if it varies! That is usually not a problem at all.
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