{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:39:13Z","timestamp":1753879153660,"version":"3.41.2"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,10,22]],"date-time":"2024-10-22T00:00:00Z","timestamp":1729555200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Spinal Cord Stimulation (SCS) is an established therapy for chronic pain, employing screening trials to identify suitable candidates before implantation. However, complications arising from both technique and medical factors present challenges to this practice. This study introduces the <jats:italic>Dural Substitute Confetti<\/jats:italic> technique, which addresses technique\u2010related complications during SCS implantation by preventing scar\u2010induced lead migration or breakage and reducing operating times.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective analysis on 174 patients treated with SCS trials from 2017 to 2022 at our institution. Of these, 85.1% proceeded to permanent implantation. During trial surgery, synthetic dural substitutes (DS) were used to protect leads, which remained connected to an external pulse generator (EPG) for 20\u201328\u2009days (mean 21.4\u2009days). Utilizing the <jats:italic>DS Confetti technique<\/jats:italic>, leads were easily dissected from the DS during the second surgery and connected to an internal pulse generator (IPG). We compared complications and surgical times before and after the introduction of this technique in 2017.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Following the complete SCS trial, patients experienced over 50% pain relief, with an implant\u2010to\u2010trial ratio of 85.1% and a mean follow\u2010up of 52\u2009months. No technique\u2010related complications occurred during the trial period post\u20102017, while the pre\u20102017 group had a 3.9% lead migration rate due to scarring, necessitating re\u2010implantation. The average surgery duration decreased from 54\u2009min pre\u20102017 to 32\u2009min post\u20102017. Medical\u2010related complications included infections (2.1%) and wound dehiscence (1.3%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The <jats:italic>DS Confetti<\/jats:italic> technique prevents scar adhesion formation during screening trials, thereby facilitating and expediting the definitive SCS implantation. Additionally, it may also reduce the risk of lead migration and iatrogenic damage, potentially lowering technique\u2010related complications.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.13426","type":"journal-article","created":{"date-parts":[[2024,10,22]],"date-time":"2024-10-22T10:38:32Z","timestamp":1729593512000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preventing technique\u2010related complications in spinal cord stimulation trials: The Dural Substitute Confetti technique. A retrospective monocentric analysis"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7849-7457","authenticated-orcid":false,"given":"Alessandro","family":"Dario","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Biotechnology and Life Sciences University of Insubria, Ospedale di Circolo e Fondazione Macchi  Varese Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9287-5239","authenticated-orcid":false,"given":"Luca","family":"Ferlendis","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Biotechnology and Life Sciences University of Insubria, Ospedale di Circolo e Fondazione Macchi  Varese Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bianca","family":"Bossi","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Biotechnology and Life Sciences University of Insubria, Ospedale di Circolo e Fondazione Macchi  Varese Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davide","family":"Locatelli","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Biotechnology and Life Sciences University of Insubria, Ospedale di Circolo e Fondazione Macchi  Varese Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,10,22]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(21)00794\u20107"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-196707000-00025"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/papr.12831"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001413"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnab015"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ner.12172"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1533\u20102500.2010.00407.x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ner.13141"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001977"},{"key":"e_1_2_10_11_1","first-page":"2820","volume-title":"Neuromodulation for the management of chronic pain: implanted spinal cord stimulators and intrathecal analgesic delivery pumps. 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