Journal de la douleur et du soulagement

Abstrait

Decreased Radiation Exposure with Percutaneous Shielded Lead Compared to Unshielded Implant for Spinal Cord Stimulation

Nathalie Zaidman, Brice Constant, Cristo Chaskis and Laurence Abeloos*

Background: Spinal cord stimulation (SCS) is a safe and effective treatment for refractory failed back surgery syndrome (FBSS). Two implantation procedures exist depending on the use of a surgical versus percutaneous lead. Percutaneous leads implantation is less invasive but the placement procedure requires a higher X-ray exposure. The new MRI compatible shielded percutaneous leads (Vectris®) appear to be stiffer and therefore seem to be easier to implant compared to unshielded percutaneous electrodes (Octad®). The aim of this study is to compare the radiation exposure between percutaneous shielded leads and percutaneous unshielded leads in SCS implantation.

Setting: Retrospective study.

Material and methods: 20 patients successively underwent SCS for FBSS. The first 10 patients were implanted with an Octad ® lead and the 10 following with a shielded Vectris ® lead. All patients were operated on by the same surgical team. In all cases, the same intra-operative X-rays device (Ziehm Vision 8000®) was used, with identical parameters aiming at a minimal X-rays exposure (pulse mode with 2 impulses/sec, and automatic mode for kVp and mAs).

Results: Fluoroscopy time was significantly lower in patients implanted with the Vectris® lead (mean: 99 seconds) compared to the Octad® lead (mean: 291 seconds) (p=0.0035). Subsequently, total patient X-rays exposure in the Vectris group (mean 592 cGycm2) was significantly lower than in the Octad® group (mean: 1899 cGycm2) (p=0.0005).

Conclusion: The use of MRI compatible shielded percutaneous leads significantly reduces the fluoroscopy time and the total X-ray exposure in SCS implantation.