Table 2. Pearls and Pitfalls.

Pearls

Potential Pitfalls

Increase the precision of paddle placement using the Roton micro tool to steer paddle lead from rostral laminotomy. To minimize torque on paddles and reduce the risk of paddle lead rotation or migration, create a "drill-groove" at the anterior aspect of the lamina- frees paddle lead course and anchor suture sleeve.  “Double-Barrell” approach to overcome recalcitrant lead resistance. It provides visual and physical access to leads (Figure 2)

Inherent technical challenges due to tight and deep joint Pneumothorax. Minimize risk by using the tunnel technique from the thoracic incision toward the gluteal pocket Epidural scar obstruction. Restore midline lead placement with Codman 59-1080 brain spatula.