Hiroshi Inagaki
Spinal cord stimulation (SCS) is an established neuromodulatory therapy for refractory chronic pain; however, the timing of SCS initiation has received relatively little attention. In some patients requiring spine surgery, the indication for SCS is already present at the time of surgery. Percutaneous leads combine reversibility with low invasiveness, allowing the timing of SCS introduction to be matched to clinical need. We describe a technical approach for simultaneous percutaneous SCS lead placement during spine surgery and present a retrospective case series of five illustrative cases. This report discusses the significance of this approach from the perspective of SCS timing, invasiveness, and reversibility. In two patients, the therapeutic objective was achieved during the acute postoperative period, and the leads were electively removed without recurrence. In three patients, continued stimulation benefit was observed, and an implantable pulse generator was placed for permanent use. No procedure-related adverse events occurred. Simultaneous percutaneous SCS lead placement during spine surgery may allow neuromodulation to be delivered at the time it is needed, for the duration it is required, and at the relevant spinal level.