Medical Student Washington University School of Medicine St. Louis, Missouri, United States
Disclosure(s):
Justin K. Zhang, BS: No financial relationships to disclose
Introduction: The field of neurosurgery is rapidly evolving, with advancements in medical technologies continuing to improve patient care. In recent years, spinal cord stimulators (SCS) have seen an exponential growth, revolutionizing the way providers treat chronic pain. Currently, however, SCS lead placement is limited by existing instrumentation, which may prolong operative time and increase risk for complications. In this brief technical note, we introduce a modified bayonet forceps, designed to refine one small but important step in the placement of SCS.
Methods: We performed a systematic analysis of the current literature and identified workflow flaws that preclude ease-of-use and accuracy of placement of the spinal cord stimulator. Specifically, we investigated limitations in the use of bayonet forceps, traditionally used to place paddle leads. In addition, we examined methods to improve ease-of-use, specifically with respect to electrode wires that are often cumbersome to control.
Results: After a period of adaptation and iterative feedback with the medical device company, we developed a modified standard bayonet forceps to include hooked ends with a ribbed surface, providing the surgeon with greater control and traction over the electrode. In addition, we attached bilateral metal tubes approximately 4 cm proximal from the edge of the forceps to feed the electrode wires through, serving to anchor the device in place during electrode placement. The modified bayonet forceps was used intraoperatively for placement of three spinal cord stimulators. In our experience, the instrument improved the steerability of the entire construct, allowing for easier placement with less OR time dedicated to fluoroscopic and stimulation confirmation of midline placement. There were no complications associated with use of the modified bayonet forceps.
Conclusion : Our modified bayonet forceps increased steerability and efficiency without sacrificing accuracy. In our experience, the modified bayonet forceps provided superior traction of the paddle electrode, improving ease-of-use.
