Modulation of Chronic Pain Using Multicolumn Paddle Lead Spinal Cord Stimulation

Start with a patient diagnosed with failed back surgery syndrome, characterized by persistent chronic lower back pain following the spinal surgeries.

For this treatment, the patient had a multicolumn paddle lead pre-implanted over the spinal cord, positioned at the midline of the T8--T9 vertebral level.

This placement targets the spinal segments that transmit pain signals from the lower back to the brain.

The multicolumn paddle lead features a series of electrodes designed to deliver focused stimulation to the spinal cord.

Next, connect the lead to an external pulse generator.

Deliver electrical pulses through the implanted lead to generate paresthesia--a tingling sensation that overlaps with the patient's painful region.

This stimulation activates non-painful sensory pathways, interrupting pain signals before they ascend to higher centers in the brain.

As a result, the patient's perception of lower back pain is reduced, improving overall comfort.

A few hours after the surgery, connect the external neurostimulator to the extrinsic external lead extensions, and place the clinician programmer onto the external neurostimulator.

Turn on the clinician programmer and the neurostimulation with a pulse width set to 260 milliseconds, at a rate of 60 Hertz. Next, use the guarded cathode configuration to first test a transverse tripolar configuration at the top of the lead. If this configuration provides sufficient paresthesia coverage and/or pain suppression, increase the pulse width to 450 milliseconds to fine-tune the back pain area coverage, and to allow enlargement of the stimulation area, adjusting the pulse rate between 40 and 60 Hertz to obtain the most satisfying paresthesia coverage of the painful area.

Then, use sharp scissors to cut the external extension flush with the skin, to reduce the risk of infection until the next surgical procedure.