![dorsal column stimulator paddle placement dorsal column stimulator paddle placement](https://ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/d710fad06db47654e4be6c2d1df9de2e9ce809fd/2-Figure2-1.png)
Widespread research on the usage of SCS has led to a large body of literature that demonstrates the efficacy of SCS treatment. The impulse produced by the leads effectively blocks the transmission of pain signaling in the dorsal column. A spinal cord stimulator device is composed of a lead and a pulse generator, which are both implanted completely underneath the skin. Blocking these signals at this level, the dorsal columns initiate a pain control mechanism that can inhibit the actual sensation and body’s experience with pain.
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As these signals travel along this pathway repeatedly, the strength of this connection solidifies, just as memory does, and can become chronic. These stimuli are sent through the dorsal columns of the spinal cord, up to the thalamus, and then the somatosensory cortex. Pain and its effects on people are complex, multifaceted phenomena, which involve pain nociceptors in the body picking up stimuli that are interpreted as painful. The patient continues to do well without any signs of cerebrospinal fluid leakage. Nonabsorbable skin sutures were removed two weeks postoperatively. After one week of no leaking or fluid collection at the thoracic incision, the lumbar drain was removed, and the patient was discharged home a few days later. A lumbar drain was placed and spinal fluid was drained for one week while the thoracic dural repair was healing. The dural defect was closed with muscle onlay graft, Prolene sutures, and DuraSeal (Integra LifeSciences, Princeton, NJ), a polyethylene glycol hydrogel. Multiple old Prolene sutures (Ethicon Inc., Somerville, NJ) were identified surrounding a large dural defect, indicating an unsuccessful closure attempt in the past. During surgery, the paddle was found floating in the middle of a large extradural cerebrospinal fluid collection. The patient underwent a thoracic laminectomy for the repair of the cerebrospinal fluid leak and fistula closure with the removal of implanted spinal cord stimulator and lumbar drain placement.
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A: preoperative T2 sagittal MRI shows a pseudomeningocele (black arrow) and a spinal cord stimulator paddle (white arrow) B: preoperative T2 axial MRI redemonstrates the pseudomeningocele (black arrow) C: intraoperative fluoroscopic imaging shows the spinal cord stimulator paddle (white arrow)