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Leads or paddles ... How do I decide? Please help - lots of questions!


I have come to the end of my pain management journey and have now been told by both my PM and my NS that the only course left for me is a SCS.

A little background ... For some reason my body takes a very long time to metabolise medication. This means that I can only take a small amount of opioid meds before my body gets overloaded. It reacts by giving me massive migraines that can't be treated. It also means I can't take meds such as Lyrica or Gabapentin because even a children's dose of the medication is too strong.

Anyway - my problem is that I have to choose between the two types and I have no idea how to do that. My PM will do the trial so that's not a problem. My PM has suggested I choose the leads because they can be removed if there is a problem. My NS does the paddles. I am seeing both of them next week.

* What are the the questions that I should ask?

* Why did you choose the path that you went down?

* If you got to choose again - would you make the same choice?

* Is there anyone out there who has had major complications (apart from infection) with either type?

* For those who have had infection - have any of you ended up with permanent damage as a result?

I know I am asking a lot but I am so confused and conflicted right now. I haven't had a good run with my surgeries. The things that have gone wrong are virtually unheard of so both my NS and I have come to the conclusion that I need to be prepared for the unexpected before I have any further surgery done. (My husband thinks I have the luck of a Lottery winner - just at the opposite end!)



  • RickilalasRRickilalas Posts: 559
    edited 05/08/2013 - 7:41 PM
    This information is from my experience getting a lumbar SCS and having both lumbar and cervical trials.
    I am a lot like you also what can go wrong will go wrong but we have to keep trying.
    When you have your trial they will use percutaneous (perc)leads which are slipped up into the spinal canal and left floating in a way because they are not attached. When you get the implant they can go a couple of ways. They can use perc leads that float which is not good for coverage and they can migrate very easy which is not good. They can do small laminectomys and attach perc leads so they stay in place. We have one member who had it done that way and she has good results. My lumbar unit was implanted and both my PM doc and my surgeon wanted paddle leads placed with laminectomys for me. They both stated they had better luck with paddles staying in place. If you go to a SCS company like medtronics web site you can find pictures of the leads not a lot of difference. Its my belief the position of the leads and how they are attached is more important then the leads themselves

    I am 2 1/2 years out on my lumbar implant with paddles and no problems and great coverage.
    I was told by my PM that some PMs will do the perc leads and the implant without any laminectomys ( I hope I am spelling that right) so that they keep the money in house without thinking about what is best for the patient. I don't know about that for sure but my PM did the trials and my spine surgeon did the implant. I was not able to have the cervical implant because there was not room for the leads to be placed in the normal way. Maybe some day I will get it done.

    Infection can be a major problem. Mel on here had a thread when she was having her implant. She had a infection which she was fighting and we have not been in touch , I don't know how she is doing. At one time they thought I may be getting a infection.
    They hit me with major antibiotics and said if I did have a infection in a few days they would have to remove the complete implant and leads then wait for six months to a year to try again.
    VERY important for a trial and implant to keep it dry and clean until fully healed

    I would ask if needed could the paddles be removed as easy or as safe as the perc leads could be removed. I can only think of two reasons this might come into play. One would be if it didn't help and or became infected later and two would be for test like a MRI.
    The only draw back I have had from my implant was no MRIs. Everything was going good then I had a stroke and had four or five CTs. Then spine acted up and I needed three CT mylos had surgery and then had to have three more CT mylograms.
    Way to much radiation I have been told and I have to wait awhile before anymore can be done. If I knew this ahead of time I would have passed on the CTs after the stroke because recovery was quick and no side effects.

    This is a lot for people to make a decision on in a short time period. You have to trust your doctors as to what is best for you.
    Then the trial has to work for you also. I like to say this is a tool to help but it is not a cure , many get good to great results and several do not. My personal opinion is that the skill of the surgeon and the skill of the rep who will do your programing and reprogramming can make or break this chance of pain relief.

    Another question would be what brand and how good the support from the reps in your area is and also what is the cost of a replacement remote control. My company has given me a remote for no charge. We have been told on here some company's charge $1200 for a remote replacement or less for a repair. Seems like a lot to me. I can meet a rep and get one free or they will mail me one when needed. They are almost like a TV remote control and will not last forever.

    Last comment
    On the infection issue I was told what makes it a problem is a infection can get onto the leads and travel right into the spinal canal making it dangerous and hard to treat.. My surgeon did my implant and sent me home from the hospital as soon as I was awake. I wasn't happy about it, most stay one night but he wanted me out so I did not get a bug..I understood it after he explained it.
    Good Luck. I hope it helps you. I can't even think what my life would be without pain meds and my SCS.

    Feel free to ask anything else or PM me. The trial is simple read the post I left for Ms Pixie and the post for MelW plus under this thread other are many more post with really good information. I will not kid you the trail is uncomfortable for less then a hour but the implant is worse then what the doctors say. Plan on doing nothing but laying in bed the first five days after the implant in pain. I hope they can find some kind of pain meds for you for that. I hope more chip in here so you get more information without over loading you. Take your time and think it through.

  • CherylCCCherylC Posts: 199
    edited 05/04/2013 - 11:09 PM
    Thanks for all of the information Rick. I think there is a lot to sort through. I take heart from the fact that people like yourself are willing to share with me. I am hoping that I will be able to come up with a list of questions to take to both my doctors later in the week.

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  • lbfrndflllbfrndfl Posts: 38
    edited 05/06/2013 - 8:35 AM
    Just my experience, but the leads can be an issue if you are active, they can move or in my case even break. After 9 years of having leads replaced 3 times I switched to paddles sewn into my spinal column. Much more invasive procedure but I have had no problem with them since 2008. Whichever way you go, good luck.
  • RickilalasRRickilalas Posts: 559
    edited 05/06/2013 - 2:08 PM
    Your post on leads was the point I was trying to make.
    Perc leads left floating are going to be a issue. We have a member here that had the perc leads but her doctor also did laminectomys to attach the leads which has worked well for her. She travels and plays golf.
    No matter what the paddle leads must be placed in with laminectomys and attached. This looks like the best way to go for me for stability and constant coverage.

    Then again no matter which leads you get you must be careful and allow them to scar in for better results in the long run.

    I hope your new ones work out. Oh and yes the surgeons skill and the extra length of leads they place in and loop at pivot points helps also
  • The leads aren't left "floating" in the spinal canal. Percuntaneous leads are anchored in multiple locations to keep everything in place. The key to implanting percuntaneous leads is to make sure a proper restraining loop is used and the patient refrains from strenuous activity for 3 to 6 months after the surgery so the leads can properly scar in place. I have had my Medtronics SCS for 4 1/2 years now. I have percuntaneous leads and they haven't moved at all since my implant.

    I'm very active. I do gardening, mowed the lawn on a couple of occasions, play golf, and have even done Zumba with my daughters.

    Either lead will do the job. One big difference between the leads is that the paddle leads will consume less power because the signal is directed in one direction where the percuntaneous signal is 360 degrees.

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  • RickilalasRRickilalas Posts: 559
    edited 05/07/2013 - 12:08 PM
    Some people have had perc leads left floating. These were done without a surgeon.
    Some times leads are called surgical and non surgical leads because of the way they are implanted.
    Your leads were placed with laminectomys right?
    I was using your example of perc leads being placed and anchored in. If I remember right you had perc leads with lamenectomys that were stitched in place so they did not migrate before scarring in right? l have met people that used loose or what I call floating leads that were placed without laminectomys and can only be anchored where they enter the spinal canal. They have not had good results because of migration.
    My point was either lead used should work if anchored at the site by means of laminectomys
    Are you saying I have it wrong? Show me if I am. It seems some times no matter what I say, you do not agree with me. My question would be if no laminectomys are done how could a lead at the electrode end be attached and not migrate?

    I gave three examples of the way leads can be used
    Perc leads floating because they are only attached at the place of entry to the canal. No laminectomys done. Just like the trial leads are placed.
    Perc leads with laminectomys so leads can be attached at the electrode area. ( perc leads but also called surgical leads when placed with surgery and stitched in place at he electrode end)
    Paddle leads placed by laminectomys only and attached in place.

    If I understand you, you are saying perc leads will scar in if not attached at the place where the electrodes are, at the end of the leads. How?

    Has you can see there are many opinions on his. I did a lot of research before I made my choice of going with paddles. My surgeon was very heavy into the trials and test of SCS units before they were a regular treatment for pain relief. I was part of a trial of bone growth stimulators with this same surgeon before insurance covered them. The results were all good. The VA and most insurance co do cover them now.. My surgeon spent a lot of time with me on both SCS stimulators and Bone Growth stimulators which both turned out with very good results. He did trials with several company's and does not recommend one over the over when asked which is best. He did install a medtronics scs on me when it came down to it but I truly think the BS is just has good but it appears the remotes are costly at a later date. My PM wants to try a BS scs on me with leads at another level to see if it would cover my left foot better then the medtronics does. To me it would not be a fair comparison because those leads will be at another level which changes everything.
    Plus I will not give up my medtronics unit because it covers all my pain from the waist down except for my left foot which could be caused from issues above my paddle to start with.

    Just spend time and ask your doctors what they feel is best for you. We have to learn to trust them. The information I relay is from my experience and the many conversations I have had with my doctors and reps. Yes I did meet with reps from other companies also. If my doctor did not make a choice for me I would have used medtronics because in my case their reps just seemed to have more information they would share with me.

    Another question to ask is how many electrodes will they be using. 16 was the most when mine was done. That could be two leads each with 8 electrodes or one paddle that has two lines to it but on stick with 16 electrodes evenly spaced on it. Some times doctors want to use a paddle but can not because there is not enough room for it. There are smaller paddles and leads with fewer then 16 electrodes but the more electrodes the better chance of getting better coverage and the more programing the rep can do.
    A example of this is on a paddle or lead they can change one electrode to negative or positive polarity and then mix them up using two or any combination of the other electrodes. I did not do the math but I was told with 16 electrodes they can make aprox 44 million different combinations. This is why your rep who will program you is soooo important.
    Again Good Luck and I hope we don't confuse you any.

  • I didn't have another Laminectomy to implant my leads. My leads are at the base of my thoracic and the top of my lumbar spines. The doctor who did my implant is a pain management doctor. I've had laminectomies all the way up to my L3 vertebrae which is where my leads are anchored in, right below the L2 vertebrae. What happens after the surgery is scar tissue will form all around the leads holding them in place. That's why they do an impedance check right after surgery and several months later to gauge how much scar tissue has built up around the lead. That's the reason why it usually requires so many programming sessions in the beginning to get things right.

  • RickilalasRRickilalas Posts: 559
    edited 05/08/2013 - 7:47 PM
    Your making my point. Your leads are attached if I understand you at the entry level to the canal and not at the end of the leads where the electrodes are. Correct ? If so they are actually floating or maybe a better word would be laying in place until they scared in. The loops and attachment you mention sounds like the loops outside of the spine between the spine and the unit. Yes extra lead material is left there for motion. I am talking about motion only inside the canal and floating inside the canal.
    My surgeon and PM stated that if they were not attached ( the electrode end) that they were floating.
    Now I know the area is tight and just tissue inside the canal may hold them in place until they scar in.
    My paddle was placed with laminectomys and the paddle itself was stitched in on two levels to help it not migrate. Paddles done like this still have issues and need reprogramming several times until full scaring in just like yours. Even attached movement can cause them to move enough to throw off the programming. It was about a year before mine were really set.
    Its interesting and in no way anything against you but before doing my SCS I had several PMs in a pain clinic, and then moved on to a PM starting his own practice and my spine surgeon all said when a PM does a scs implant with perc leads he is doing it for him not the patient. $$$$
    All of them from different places said the normal procedure for us is the PM does the trial with perc leads then a surgeon does the implant with with surgical leads or a paddle. Then the leads or paddle are attached just below the electrodes and above the electrodes to hold them in place. It looks like most of the members here have had a PM trial and a surgeon do the implant.
    If it wasn't important I wonder why there doing it this way.

    My cervical trial was done with perc leads like all trials. One exception was they could not get into the canal any where above my lumbar area. My leads went from L2 L3 to C3 C2 area. They were stitched in at the lumbar entry point. Would you say these are attached or floating in that aprox. 30 inch area.
    I hope you understand what I am saying. This also makes a large difference in recovery time.
    Perc or non surgical leads are simple like the trial. Paddles require laminectomys to attach which
    changes a simple procedure to a almost major surgery. In my case the first two laminectomys were done and the paddle placed, a test done with coverage not being good. They decided to do two more and move the paddle up which gave me coverage from the waist down and also some lower back coverage. This is not a easy surgery and takes time to get over but very much worth it.

    I see the difference between the ways ours have been done. I also wonder which unit you have.
    I am about three years past implant I use mine pretty much 24 hours a day and only have to recharge
    around every two weeks. I think I read where you have to recharge every three to four days, is that right.

    Regardless of the differences I am happy that yours works for you.
  • Did you see the doc yet and get a date?

    Good luck

  • Thank you both for all of your help. It has been good to read thoughts from both perspectives and has given my a lot to think about.

    Rick - am going to see my NS this afternoon. Have a lot of questions for him. Not likely to get a date straight away regardless of which method I choose but at least will be able to get moving on the approval process. Will let you know how it goes.
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