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The Wake Up Test For Spinal Cord Stimulator Placement


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Spinal Cord Stimulation

The Wake Up Test For Spinal Cord Stimulator Placement

Shihlong Yeh MD, Scott Mellender MD, William Grubb MD,  Kang Rah MD,
Shruti Shah MD, Ashraf Sakr MD, Branson Collins MD, and Christine Hunter MD.
Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
 
Introduction: The intraoperative wake-up test is the "gold standard" to detect intraoperative compromise of the spinal cord in surgical procedures involving the vertebral column. We believe that it is also useful in the placement of permanent spinal cord stimulators involving paddle leads.
 
Methods: A sixty-year old female, with a history of chronic back pain and degenerative disc disease, was recommended lumbar decompression and fusion by neurosurgery. The patient elected to avoid surgery and undergo a spinal cord stimulator trial. A successful stimulator trial was performed, with the patient experiencing significant pain relief. During the trial, x-rays of the stimulator leads were taken to document the location of the leads.                  The patient was referred to neurosurgery for permanent spinal cord stimulator placement with a paddle lead.  The neurosurgeon reviewed the x-rays of lead placement for the spinal cord stimulator trial. He felt that the x-rays were inadequate because they did not include the T12-L1 border; therefore, he could not confirm the exact placement of the leads. He asked the patient to repeat the spinal cord stimulator trial, and perform new x-rays, of the leads, with the T12-L1 border. The patient refused to repeat the trial, so the surgeon offered to perform the permanent placement of the spinal cord stimulator, if she agreed to an intraoperative wake-up test.
                 After informed consent was obtained, the patient was brought to the operating room and placed under general endotracheal anesthesia. She was woken up after placement of the paddle lead. The paddle lead was turned on.  She was asked to confirm that spinal cord stimulation was covering her chronic back pain. Using hand signals, she confirmed that the paddle lead was in the correct location to cover the distribution of her chronic back pain. After the wake-up test, the maintenance of anesthesia was continued. The surgery was completed, and the patient was brought to the recovery room. 
Results: The patient was interviewed post-operatively, and she suffered no ill effects from the intraoperative wake-up test. The patient's spinal cord stimulator is giving her significant relief from her chronic back pain. 
Conclusions: The intraoperative wake-up test is an effective and safe diagnostic tool for placing permanent spinal cord stimulators involving paddle leads.