Objective

Current published guidelines recommend advanced imaging, specifically, thoracic magnetic resonance imaging (MRI), prior to implantation of epidural paddle spinal cord stimulator (SCS) leads. Preoperative imaging may affect surgical approach to minimize risk of complications. We aimed to assess the impact of preoperative thoracic MRI on surgical planning in a large series of surgical paddle SCS lead placements in a real-world setting.

Materials and Methods

This is a retrospective study of a prospectively maintained data base of 160 patients treated by SCS with awake thoracic surgical paddle lead placement in a single academic functional neurosurgery center from 2013 to 2021. All patients had a thoracic MRI prior to implantation. Abnormal MRI findings were reviewed to determine their potential impact on the safety of surgical paddle lead placement. A minor impact was defined as anatomical areas to avoid with paddle lead placement. Major impacts included significant deviations from standard approach to electrode placement.

Results

None of the 160 patients had signs or symptoms referable to thoracic spine pathology prior to lead implant. Sixty-seven had abnormal thoracic MRI findings, and 36 had abnormal MRI findings that impacted surgical planning. Thirty-one patients had MRI findings with minor impact. Five patients (more than 3%) had findings with major impact.

Conclusions

This is the largest case series assessing the impact of preoperative thoracic MRI on surgical planning for patients undergoing paddle SCS placement. Twenty-two percent of patients had MRI findings that impacted surgical planning with 3% requiring additional surgical decompression for safe paddle lead placement. Without advanced imaging to inform surgical planning, unnecessary risk may have been placed on these patients. Although such imaging has been recommended by consensus committees in published guidelines, our study is the first to present a large institutional experience of real-world data that demonstrates its importance.

中文翻译：

---

用于脊髓刺激的术前胸椎磁共振成像：这样的建议是否应该是绝对要求？

客观的

当前发布的指南建议在植入硬膜外桨式脊髓刺激器 (SCS) 导线之前进行高级成像，特别是胸部磁共振成像 (MRI)。术前成像可能会影响手术方法，以尽量减少并发症的风险。我们旨在评估术前胸部 MRI 对真实世界环境中大量手术桨 SCS 引线放置的手术计划的影响。

材料和方法

这是一项前瞻性维护数据库的回顾性研究，该数据库包含 2013 年至 2021 年在单个学术功能神经外科中心接受 SCS 治疗的 160 名患者，这些患者在清醒的胸外科手术桨电极导线放置。所有患者在植入前都进行了胸部 MRI。对异常的 MRI 结果进行了审查，以确定它们对手术桨电极放置安全性的潜在影响。轻微影响被定义为放置桨式导线时要避免的解剖区域。主要影响包括电极放置标准方法的重大偏差。

结果

160 名患者在植入导线前均未出现与胸椎病理相关的体征或症状。67 人的胸部 MRI 表现异常，36 人的 MRI 表现异常影响了手术计划。31 名患者的 MRI 结果影响较小。五名患者（超过 3%）的发现具有重大影响。

结论

这是最大的病例系列评估术前胸部 MRI 对接受桨 SCS 放置的患者的手术计划的影响。22% 的患者 MRI 发现影响了手术计划，其中 3% 的患者需要额外的手术减压以安全放置电极片。如果没有先进的成像技术来为手术计划提供信息，这些患者可能会面临不必要的风险。尽管共识委员会在已发表的指南中推荐了此类成像，但我们的研究首次展示了真实世界数据的大型机构经验，证明了其重要性。