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The trial procedure involves placing the wires (leads) in the epidural space near the spinal cord and connecting them to an external stimulator that is carried in a fabric pouch worn around the patient’s waist.
- Who May Benefit From Spinal Cord Stimulation
Spinal cord stimulation is most successful in treating...
- Disadvantages and Risks of Spinal Cord Stimulation
Additionally, as with any surgical implant procedure, there...
- Spinal Cord Stimulation Procedure
Spinal cord stimulator implantation is a minimally invasive...
- Who May Benefit From Spinal Cord Stimulation
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A Spinal Cord Stimulator Trial is a procedural test in which temporary wires, called leads, are threaded through a needle into the epidural space in the back or neck area. The epidural space is an area located outside of the spinal cord area.
Spinal cord stimulator implantation is a minimally invasive procedure that involves inserting wires near the spinal cord and placing the stimulator under the skin.
- Name of Procedure
- Goal
- Indications
- Contraindications
- Equipment/Skills/Setup
- Landmarks and Patient Positioning
- Technique
- Lead Removal
- Tips
- References
Percutaneous Spinal Cord Stimulator Trial Lead PlacementSCS TrialTo place midline (as opposed to dorsal root ganglion) spinal cord stimulator leads as part of a trial phase before a spinal cord stimulator implant.
A variety of pain can be treated with spinal cord stimulators but commonly for radicular pain, CRPS, peripheral neuropathy.
Core Skills: See our guides to obtain images of the cervical, thoracic, or lumbar spine. Then steer a needle to direct it under the skin. Typically spinal cord stimulator trials are placed with the kit provided by the manufacturer and everything needed should be in there. Special items and suggested setup for this procedure: 1. 10cc 1% lidocaine in...
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. For the purposes of this article we’ll focus on stimulators for low back and leg pain.
Overview
There are a few levels to keep in mind: 1. Where the top of your stimulator leads need to land. This depends on the individual patient. Typically they’ll land around T8-T10. Higher pain means higher lead placement. Also, exact position might be determined by feedback from the patient during the procedure (details below) 2. The epidural access point. You’ll enter an interspace, perhaps somewhere around the low thoracic or high lumbar area. 3. The skin entry point. Like any epidural injection y...
Steps
1. Obtain a simple AP view of the low thoracic and upper lumbar spine. 2. Choose an interspace to access the epidural space. Choice depends on the above factors and if you’re placing one or two leads. We’ll assume we’re placing 2 leads so we’ll place a left and right epidural needle: 2.1. Enter the skin around L3-L4. So anesthetize there just left of midline and aim towards the L1-L2 space. 2.2. Insert the tuohy needle and aim for the L3-L4 interspace 2.3. Use your typical desired technique h...
Spinal cord stimulator trial lead removal is a simple process that can be done in office about 5-10 days after placement: 1. Make sure the unit is deactivated/off. 2. Remember to treat the lead pull as a procedure and follow blood thinner cessation guidelines. 3. The patient can be in any comfortable position. 4. Remove all bandages and pull all le...
Several factors can complicate lead steering/placement: 1. Resistance when threading the lead 1.1. Pulling and advancing the lead in repetitive small movements, with minor adjustments in steering, might help you to move past or around these pockets. 2. You may see that the lead moved of laterally slightly and then back to midline. This might be a p...
The spinal cord stimulator trial, which lasts about a week, involves stimulation through thin wires inserted into the body and controlled by an external transmitter. The trial procedure usually takes about 30 to 90 minutes and is done in a clinic, day surgery center, or hospital.
Learn about the process patients take to do a spinal cord stimulation therapy trial and get the implant.
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Trial procedure. The trial procedure generally involves a percutaneous (meaning “through the skin”) approach. During this procedure, you’re usually under sedation (light sleep). You might receive general anesthesia under certain circumstances, but this is less common.
