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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