![]() ![]() A knowledgeable rep will often be able to suggest specific lead adjustments based on feedback.The rep will be asking the patient for feedback to see if your lead placement can provide coverage over the patient’s desired area.Ideally anesthesia has been timing a wakeup around now so the rep can turn on stimulation and see if the leads are placed correctly:.Spinal cord stimulator trial leads fluoroscopy lateral spinal cord stimulator trial leads fluoroscopy lateral While the rep is getting things setup, this is a good time to check an lateral view to confirm posterior lead placement. ![]() From here you’ll start to hook the leads up the manufacturer’s connector, which in turn is connected with the device rep’s controller.Spinal cord stimulator trial leads AP fluoroscopy Spinal cord stimulator trial lead AP fluoroscopy. Once the top of the lead is at your target you simply repeat steps 2 and 3 above to place a right paramedian lead.You’ll aim to get this lead as the left paramedian lead.This is the part of the procedure that can be the most difficult and mostly takes practice (see some tips below).You’ll advance it under live fluoroscopy, while twisting/steering with the stylet till it’s in it’s final destination.Insert the first lead and advance till you feel it just exit the needle.Continue with loss of resistance to access the epidural space.Either hit lamina at L2 and walk off, or if you have good feedback and sense of depth, just aim straight to the interspace Use your typical desired technique here.Insert the tuohy needle and aim for the 元-L4 interspace.So anesthetize there just left of midline and aim towards the L1-L2 space. We’ll assume we’re placing 2 leads so we’ll place a left and right epidural needle: Choice depends on the above factors and if you’re placing one or two leads. Choose an interspace to access the epidural space.Obtain a simple AP view of the low thoracic and upper lumbar spine.Entering far lateral might cause the lead to cross over while threading (ie, if you start on the left and your needle is pointing lateral to medial when it accesses the epidural space, the lead might continue to go towards the right side while threading.).Entering the skin right above the interspace leads might require the lead to take a sharper turn when exiting the needle and trying to thread superiorly.Entering lower allows for a “flat” approach and might help a lead slide out along the same trajectory as the needle and smoothly continue that trajectory up the epidural space.Like any epidural injection you can enter the skin anywhere around your interspace, but your trajectory might affect your ability to place your lead: You’ll enter an interspace, perhaps somewhere around the low thoracic or high lumbar area. Also, exact position might be determined by feedback from the patient during the procedure (details below) Where the top of your stimulator leads need to land.For the purposes of this article we’ll focus on stimulators for low back and leg pain. Position the patient in a basic prone position so that the bottom of the c-arm can go under the table below the lumbar and thoracic spine. Device supplies (leads, anchor devices).1-2 14g tuohy needles for epidural space access.10cc 1% lidocaine in a 10cc syringe attached to a 25g x 1.5″ hypodermic needle for subcutaneous local anesthetic.Special items and suggested setup for this procedure: Typically spinal cord stimulator trials are placed with the kit provided by the manufacturer and everything needed should be in there. Then steer a needle to direct it under the skin. During the 1 week trial phase blood thinners remain held.Ĭore Skills: See our guides to obtain images of the cervical, thoracic, or lumbar spine. So blood thinner hold times are before the insertion and restart times are after lead removal.Because a trial leaves something in the epidural space for about a week, we treat the lead insertion as the beginning of the procedure and the lead removal as the end of the procedure.See details on how to handle blood thinners for various procedures based on ASRA guidelines.IndicationsĪ variety of pain can be treated with spinal cord stimulators but commonly for radicular pain, CRPS, peripheral neuropathy. To place midline (as opposed to dorsal root ganglion) spinal cord stimulator leads as part of a trial phase before a spinal cord stimulator implant. Percutaneous Spinal Cord Stimulator Trial Lead Placement. ![]()
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