IMR Press / JIN / Volume 22 / Issue 1 / DOI: 10.31083/j.jin2201006
Open Access Original Research
Proposal of a Novel Procedure for C2-4 Cervical Spinal Cord Stimulator Implantation to Improve Complete Midline Coverage via Electrode Array in Patients with Disorders of Consciousness: A Retrospective Single-Center Study
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1 Medical School of Chinese PLA, 100853 Beijing, China
2 Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, 100853 Beijing, China
3 Department of Neurosurgery, The Seventh Medical Centre, Chinese PLA General Hospital, 100700 Beijing, China
4 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100070 Beijing, China
*Correspondence: he_jianghong@sina.cn (Jianghong He); jnzhang_2022@163.com (Jianning Zhang)
Academic Editor: Sergio Bagnato
J. Integr. Neurosci. 2023, 22(1), 6; https://doi.org/10.31083/j.jin2201006
Submitted: 20 April 2022 | Revised: 29 May 2022 | Accepted: 31 May 2022 | Published: 4 January 2023
(This article belongs to the Special Issue Disorders of Consciousness: From Pathophysiology to Treatment)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Background: Deviation of electrode array from the midline of spinal cords affects the therapeutic outcomes of C2-4 cervical spinal cord stimulation (SCS) in patients with disorders of consciousness (DOC). This study proposed the implementation of a novel C2-3 dural exposure procedure and investigated its efficacy compared to conventional surgery. Methods: Surgical and postoperative imaging data from 69 patients with DOC who underwent SCS in the lateral decubitus position were retrospectively assessed. The C2-3 dural exposure procedure was performed in 16 patients while the rest underwent conventional surgery. The incidence of electrode deviation was compared, and factors associated with the deviation were investigated. Results: The rate of complete midline coverage by the electrodes in the C2-3 dural exposure group was significantly higher than the conventional group (93.8% vs. 54.7%, p = 0.004). Exposure of the dura between C2-3 was a significant favorable factor for complete midline coverage by the electrode array (odds ratio [OR]: 0.091; 95% confidence interval [CI]: 0.011–0.757; p = 0.027). Electrode positioned 5 cm above the lower edge of the C2 vertebra was a significant risk factor for incomplete midline coverage (OR: 1.126; 95% CI: 1.016–1.248; p = 0.023). No difference in operation time, intraoperative bleeding, or surgical site infection was observed between the 2 groups. Conclusions: The C2-3 dural exposure procedure, performed in the lateral decubitus position, was safe and had higher complete midline coverage than conventional surgery.

Keywords
disorders of consciousness
spinal cord stimulation
C2-4
cervical spine
midline
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