• Chen Li, Ye Jiang, Tengfei Liu, Lutao Yuan, Cong Luo, and Yong Yu.
• Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China.
• Pain Physician. 2023 Nov 1; 26 (7): E805E813E805-E813.

BackgroundSpinal cord stimulation is a technique in which different types of electrodes are placed in the spinal epidural space for neuromodulation. Surgical paddle electrodes (SEs) are usually implanted by a surgeon by performing open surgery with laminectomy. Recent advances in endoscopic spine surgery provide another option for minimally invasive SE implantation.ObjectivesThis anatomical study aims to examine the feasibility of implanting SEs in thoracic and cervical spine segments, discussing the specific advantages and disadvantages compared with previously reported methods.Study DesignLaboratory study with Institutional Review Board No B2023-056.MethodsFour fresh adult cadavers (2 women, 2 men) were operated on in this study. The posterior unilateral biportal endoscopic surgical approach, the accessibility to the intraspinal epidural space, and the technical possibilities and limitations of implantation of SEs were evaluated, as well as the surgical duration and complications.ResultsAll the planned steps of the operation were successfully accomplished in all 4 cadavers. A total of 8 electrodes were successfully implanted through the working portal. Among them, 4 were located in the cervical segment and 4 in the thoracic segment. The proper position of the electrodes was also verified by fluoroscopy. No rupture of dura occurred during the operation. Except for the first cadaver, the duration of surgery did not exceed 1 hour.LimitationsAnatomical study on human cadavers, the quantity of cadavers, and the steep learning curve.ConclusionsThe results of this anatomical study show that the SEs can be satisfactorily implanted in cervical and thoracic segments using the unilateral biportal endoscopic technique.

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