294 Spinal Cord Stimulator Paddle Lead Revision and Replacement for Misplaced or Displaced Electrodes

INTRODUCTION: Spinal cord stimulators (SCS) are commonly implanted via a laminotomy or laminectomy. Revision surgery may be necessary in instances of hardware failure or loss of efficacy. It is uncommon for leads to have been initially misplaced in a suboptimal position, and revision in these cases necessitates additional dissection for appropriate repositioning. Accordingly, there is concern for a potentially higher risk of associated complications, including dural tear, cerebrospinal fluid (CSF) leak, epidural hematoma, and neurological injury. It is well-documented that revision spinal surgery can be associated with worse outcomes. METHODS: Patients who underwent SCS paddle replacement for misplaced paddles between 2021 and 2023 were identified. Medical charts were reviewed for demographic data, operative details, and incidence of complications. RESULTS: Sixteen patients underwent thoracic SCS paddle revision and replacement. The mean age was 59.6±12.6 years, with 11 females and 5 males. Misplaced paddles were too lateral (n=12), too high (n=2), or incompletely within the epidural space (n=2). The mean duration from initial implantation to revision surgery was 44.8±47.5 months. The mean operative duration was 126.1±26.9 minutes, and all patients required a “skip” laminectomy or laminotomy. No complications were encountered. The mean length of follow-up was 18.4±7.3 months. Mean preoperative pain intensity was 7.9±1.5, and at last follow-up was 3.6±1.7 (p<0.001). All but one patient continued to use their device in follow-up. CONCLUSIONS: The revision and replacement of misplaced paddle SCS electrodes is a feasible and durable revision strategy, even in long-term implants with extensive scarring.