{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T22:14:53Z","timestamp":1771366493717,"version":"3.50.1"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,12,2]],"date-time":"2023-12-02T00:00:00Z","timestamp":1701475200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Spinal cord stimulation (SCS) is a cost\u2010effective option for treating refractory persistent spinal pain syndrome type\u20102 (PSPS\u20102). For patients with extensive spine instrumentation including the thoraco\u2010lumbar junction, percutaneous placement of SCS leads is usually not an option being paddle leads typically implanted anterograde. Paddle lead placement will be particularly challenging in more complex cases when the instrumentation covers the targeted level. To overcome this barrier, we studied using a retrograde approach to reach the sweet spot, facilitate the placement, and reduce associated risks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To study the use of retrograde SCS paddle as a placement method to optimize the spinal cord target and reduce the risks of conventional placement in complex cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Case series and technical note.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We present three cases of thoracic retrograde SCS paddle lead placement cases, detailing patient selection, operative technique, and outcome. All the cases had extensive instrumentation to the thoraco\u2010lumbar spine, and one had additional spinal canal stenosis. The surgical procedure entailed a retrograde midthoracic inter\u2010laminar approach, flavectomy, and caudal placement of the paddle lead with intraoperative neurophysiologic monitoring (IONM) guidance for functional midline determination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All the cases had a successful lead placement over the sweet spot without complications. The same approach was used to decompress a focal spinal stenosis in one case. One case had significantly improved pain and hence underwent a pulse generator implant. The other cases had non\u2010satisfactory pain control and were explanted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Limitations<\/jats:title><jats:p>These case description could guide technical procedural steps, however, a larger number of such cases would be needed to describe further technical nuances.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We demonstrated that placing SCS paddle leads via retrograde midthoracic approach with IONM guidance is safe. This procedure should be an option for SCS paddle implants in patients with posterior spinal fusion encompassing the intended targeted spinal stimulation level.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.13322","type":"journal-article","created":{"date-parts":[[2023,12,2]],"date-time":"2023-12-02T19:50:23Z","timestamp":1701546623000},"page":"483-488","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Retrograde thoracic spinal cord stimulation paddle placement for complex persistent spinal pain syndrome type 2"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2475-9228","authenticated-orcid":false,"given":"Bernardo Assumpcao","family":"de Monaco","sequence":"first","affiliation":[{"name":"Neurological Surgery Department University of Miami  Miami Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1907-4558","authenticated-orcid":false,"given":"Guilherme Santos","family":"Piedade","sequence":"additional","affiliation":[{"name":"Neurological Surgery Department University of Miami  Miami Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Doomi","sequence":"additional","affiliation":[{"name":"Neurological Surgery Department University of Miami  Miami Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan R.","family":"Jagid","sequence":"additional","affiliation":[{"name":"Neurological Surgery Department University of Miami  Miami Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timoteo","family":"Almeida","sequence":"additional","affiliation":[{"name":"Radiation Oncology Department University of Miami  Miami Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8709-6644","authenticated-orcid":false,"given":"Joacir Graciolli","family":"Cordeiro","sequence":"additional","affiliation":[{"name":"Neurological Surgery Department University of Miami  Miami Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,12,2]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ner.12208"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2007.07.028"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000144839.65524.E0"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/pme.12146"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-200207000-00016"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00540-011-1311-4"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2021.07.077"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02511237"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1403.2007.00085.x"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2019.00905"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1109\/86.712224"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/ner.12138"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ner.12084"},{"issue":"5","key":"e_1_2_11_15_1","article-title":"Permanent paddle\u2010lead trial for spinal cord stimulation","volume":"10","author":"Lee JJ","year":"2018","journal-title":"Cureus"},{"issue":"12","key":"e_1_2_11_16_1","first-page":"334","article-title":"Cervical retrograde spinal cord stimulation Lead placement to treat failed Back surgery syndrome: a case report","volume":"8","author":"Helmond N","year":"2017","journal-title":"Case Rep"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/ner.12174"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurom.2022.01.012"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-021-05107-4"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1403.2010.00319.x"},{"key":"e_1_2_11_21_1","first-page":"116","article-title":"Implante de Eletrodo epidural Para Tratamento da dor Cr\u00f4nica: Como determinar a linha m\u00e9dia funcional? 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How to determine the functional midline?","volume":"30","author":"Guarnieri J","year":"2019","journal-title":"J Brasileiro de Neurocirurgia"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.36076\/ppj.2012\/15\/1"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/ner.13491"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurom.2022.02.228"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S349101"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/ner.12158"}],"container-title":["Pain Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/papr.13322","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T08:34:03Z","timestamp":1710318843000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/papr.13322"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,2]]},"references-count":25,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1111\/papr.13322"],"URL":"https:\/\/doi.org\/10.1111\/papr.13322","archive":["Portico"],"relation":{},"ISSN":["1530-7085","1533-2500"],"issn-type":[{"value":"1530-7085","type":"print"},{"value":"1533-2500","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,2]]},"assertion":[{"value":"2023-05-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}