A tubular retractor, followed by a percutaneous working cannula, was used until reaching the intersection of the blade with the inferior articular process of T12, causing the cannula to be positioned in the caudocranial direction at 30°. The incision point was made in the projection of the intersection of the lamina with the superior articular process of T11. A 14-mm right parasagittal skin and muscle fascia incision was performed. Local anesthesia with 2% lidocaine with vasoconstrictor was injected at the site of the incision. The patient was operated on while under total intravenous general anesthesia and positioned in the ventral decubitus position, marking the entry point in the anteroposterior view with costal margin count to guide the entry level the center of the T11–12 interlaminar hemi-window was marked. Right: Wider endoscopic work portal for passage of the electrode with dimensions greater than 10 mm. Left: Sketch for creating the wider endoscopic work portal for passage of the electrode with dimensions greater than 10 mm. The local anatomy was assessed with magnetic resonance imaging of the lumbar spine, and electrode implantation was chosen endoscopically via interlaminar uniportal access. To do so, it was necessary to create a wider endoscopic work portal, with the distal portion allowing better visualization of the attached structures ( Fig. He used daily duloxetine 120 mg\day, gabapentin 1800 mg\day, and methadone 40 mg\day for pain control.Īfter performing a neurostimulation test with a percutaneous test electrode for 5 days, we decided to place an Abbott Penta paddle electrode via endoscopy. He also had motor deficit with an M3 strength motor deficit for dorsiflexion and plantar extension and preserved sphincter control. On physical examination, he presented peroneal paresthesia radiating to the lateral and posterior face of the lower limbs. According to his past clinical data, he had diagnosed arthrosis in the right and left hip, with arthroplasty on the right. He had been experiencing chronic low back pain since then. He underwent decompressive surgery 8 days after this clinical episode started.
Searches of PubMed, Cochrane, and Lilacs databases were conducted, revealing no evidence of studies or mentions in the literature that enable the passage of an electrode with a width greater than 10 mm via endoscopy.Ī 61-year-old male patient had a disc herniation at the 元–4 level that evolved to a cauda equina syndrome 5 years prior to our evaluation. The Penta paddle electrode from Abbott is 11 mm wide, making it impossible to pass through the endoscopic work portal for canal stenosis, which is 10 mm. In this regard, differences are evident in terms of paddle width, electrode length, number of poles, and matrix width and length. In Brazil there are three brands of paddle electrodes: Medtronic, Boston, and Abbott-St. 5 The endoscopic technique has stood out and evolved quickly and strongly in the treatment of various pathologies of the spine, so that the use of the endoscope through single-portal access to implant a paddle electrode was suggested.Īmong the main aspects of the benefits of endoscopic surgery for implantation of the electrode, there is a smaller incision in the skin, negligible bleeding, a lower risk of complications such as infection, and a considerable reduction in pain in the postoperative period, consequently reducing analgesia in the postoperative period. 1–4Ĭurrently, with technological developments and the improvement in surgical methods, there is evidence of an increase in minimally invasive procedures, especially for the treatment of pathologies of the spine, such as cervical, thoracic, and lumbar disc herniations and spinal canal stenosis. The aim is to reduce pain and unpleasant sensory experiences, improving the patient’s quality of life, functioning, and vitality. Spinal cord stimulation is a prevalent neuromodulation technique with a high level of evidence for the successful treatment of chronic neuropathic pain refractory to conservative treatment.