Technical Considerations in Percutaneous Placement of Spinal Cord Stimulation Devices.
Introduction:
The last several decades have witnessed exponential advances in the technology and use of spinal cord neuromodulation for the treatment of chronic refractory pain syndromes in patients whom medical and surgical management have been exhausted. This chapter focuses on the technical aspects of percutaneous placement of SCN devices, emphasizing patient selection, technique, and complications.
The precise mechanism of spinal cord modulation for neuropathic pain is partially understood. The original ‘control gate theory’ postulated that continual activation of afferent fibers within the dorsal columns of the spinal cord inhibited transmission of …show more content…
The lead tunneler is advanced subcutaneously in the lateral direction, to the site where the pulse generator will be placed. The tunneler allows for passage of a straw device from the midline to the lateral exit site, where leads are then subsequently attached to the straw device and pulled laterally through the tunneled path out to the exit site. The skin incision is irrigated and closed with absorbable sutures for the subcutaneous tissues and nylon sutures, liquid adhesive/durabond and or staples are used to close the …show more content…
Common device related complications include lead migration, fracture, and hardware malfunction(12). Patient related complications include infection, hematoma, CSF leaks, seromas, or pain (7, 8, 12).
Recognition of typical stimulation patterns is required to understand where an electrode may be positioned. Stimulation should be confined entirely to the dorsal columns, with paresthesias occurring ipsilateral and caudal to the electrode(13). Stimulation patterns that result in abdominal tightness or chest wall sensations, may indicate that a lead is positioned in the anterior epidural space. Intradural placement or placement adjacent to an exiting nerve root produces sensations that occur at extremely low amplitudes or within a narrow
Introduction:
The last several decades have witnessed exponential advances in the technology and use of spinal cord neuromodulation for the treatment of chronic refractory pain syndromes in patients whom medical and surgical management have been exhausted. This chapter focuses on the technical aspects of percutaneous placement of SCN devices, emphasizing patient selection, technique, and complications.
The precise mechanism of spinal cord modulation for neuropathic pain is partially understood. The original ‘control gate theory’ postulated that continual activation of afferent fibers within the dorsal columns of the spinal cord inhibited transmission of …show more content…
The lead tunneler is advanced subcutaneously in the lateral direction, to the site where the pulse generator will be placed. The tunneler allows for passage of a straw device from the midline to the lateral exit site, where leads are then subsequently attached to the straw device and pulled laterally through the tunneled path out to the exit site. The skin incision is irrigated and closed with absorbable sutures for the subcutaneous tissues and nylon sutures, liquid adhesive/durabond and or staples are used to close the …show more content…
Common device related complications include lead migration, fracture, and hardware malfunction(12). Patient related complications include infection, hematoma, CSF leaks, seromas, or pain (7, 8, 12).
Recognition of typical stimulation patterns is required to understand where an electrode may be positioned. Stimulation should be confined entirely to the dorsal columns, with paresthesias occurring ipsilateral and caudal to the electrode(13). Stimulation patterns that result in abdominal tightness or chest wall sensations, may indicate that a lead is positioned in the anterior epidural space. Intradural placement or placement adjacent to an exiting nerve root produces sensations that occur at extremely low amplitudes or within a narrow