Needle Placement for Percutaneous Spinal Cord Stimulation of the Back and Legs

Abstract

Needle placement is one of the most important procedural tasks in placing a percutaneous spinal cord stimulation device, yet it is often overlooked in regard to its impact on the overall outcome and ease of the procedure. Needle placement sets the tone for the ease of placing the lead, the angle of lead placement, and the potential for complications. It is often viewed as a simple procedure, yet it is a technique that should be performed with vigilance and planning. Prior to placing the needle, the patient must be prepared and positioned, and a fluoroscopic scout film is taken to evaluate the best route to use when placing the needle. If the patient has had instrumentation or has scoliosis or congenital spinal defects, a recent plain film should be reviewed prior to going to the operating room. If stenosis is a concern, the clinician should consider an MRI or CT scan prior to moving forward, to ensure that there is adequate room in the epidural space.