• Joel D MacDonald and Kirk J Fisher.
• Department of Neurosurgery, University of Utah, Salt Lake City, Utah 84107, USA. neuropub@hsc.utah.edu
• Neurosurgery. 2011 Sep 1;69(1 Suppl Operative):ons83-6; discussion ons86-7.

BackgroundSpinal cord stimulation is an established technology for management of chronic low back and leg pain when other surgical options have failed or are not feasible. Precise placement of the paddle-style electrode relative to the patient's distribution of pain can be difficult because of anatomic variation and the inherent limitations of electrode design.ObjectiveTo describe a surgical technique for adjustment of spinal cord stimulator epidural electrode location during placement or revision to optimize stimulation coverage.MethodsWe devised a method using a malleable disposable suture retrieval snare to precisely position an epidural electrode in either a midline or paramedian position during initial placement or revision. The snare is deployed and used to grasp a suture knot tied at the end of the electrode. The retriever is then used to position the electrode in the epidural space. Once satisfactory stimulation coverage is achieved, the snare is deployed to release the suture knot and the retriever is gently removed.ResultsWe have used this method in 15 patients thus far to achieve optimal stimulation coverage. The total time required for electrode placement and repositioning, including the stimulation trial, has been substantially reduced. The patient-reported discomfort has also been significantly reduced. No adverse consequences of the technique have occurred.ConclusionWe believe that this technique is a novel and effective method for accurately steering an epidural electrode for dorsal column stimulation for management of chronic pain.

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