1. 2011;14;195-210Alternative Approach to Needle Placement in Cervical Spinal Cord Stimulator Insertion
   Technical Report
   Gabriella Gutman, MD, Asim Husain, DO, Renato Vesga, MD, Youssef Josephson, DO, Frank J.E. Falco, MD, C. Obi Onyewu, MD, and Jie Zhu, MD.

BACKGROUND: Neuromodulation with spinal cord stimulation is a proven cost effective treatment for the management of common conditions such as chronic radicular leg pain from failed back surgery syndrome, complex regional pain syndrome, and other painful neuropathic pain syndromes. The traditionally instructed method for percutaneous spinal cord stimulator (SCS) lead placement promotes the use of a “loss of resistance” (LOR) technique under anteroposterior (AP) fluoroscopic guidance to assure midline lead placement and proper entry into the epidural space.

OBJECTIVE: To describe the relevant anatomy and method for a precise needle placement approach for placement of percutaneous cervical spinal cord stimulation (SCS) leads without loss of resistance (LOR) using a syringe. An oblique fluoroscopic view is presented demonstrating successful placement of cervical SCS leads.

DESIGN: Technical report.

SETTING: Pain management clinic.

METHODS: Discussion with accompanying fluoroscopic images. This technical report meets HIPAA compliance standards.

RESULTS: Successful placement of percutaneous SCS leads without traditional loss of resistance using an oblique fluoroscopic approach.

LIMITATIONS: Technical report only. The risks, potential complications, and benefit from this approach are beyond the scope of the article.

CONCLUSIONS: This fluoroscopic technique provides an alternative means for placing percutaneous cervical SCS leads without the use of the traditional loss of resistance technique.