Epiduroscopy-Assisted Spinal Cord Stimulator Electrode Implantation

23 Epiduroscopy-Assisted Spinal Cord Stimulator Electrode Implantation

Billy K. Huh and Carrie E. Johnson

23.1 Introduction

Epiduroscopy can be instrumental for spinal cord stimulator (SCS) electrode implantation in anatomically challenging patients. Epiduroscopy also allows precise visualization of the epidural space ( Fig. 23.1) and maneuvering of the electrode tip to its optimal position ( Fig. 23.2) when conventional technique of pushing electrode through Tuohy needle is not viable. When electrode advancement is significantly hindered by adhesion ( Fig. 23.3) or scar tissues, epiduroscopy can be used to lyse adhesions, remove scar tissue, and facilitate lead advancement.^1,2

Fig. 23.1 The epiduroscope in the ventral epidural space can clearly identify anatomic structures for lead placement.

Over time, increased scarring or fibrous growths that envelop the tip of an SCS electrode can cause the stimulation to become ineffective over time ( Fig. 23.4). Epiduroscopy allows this extraneous fibrous tissue or scarring near the implanted SCS electrode tip to be removed in order to restore the efficacy of neuromodulation after long-term use without having to replace the electrode.

Electrode tips are also vulnerable to migration over time. Epiduroscopy can help with repositioning of displaced electrodes, thereby restoring efficiency and efficacy without replacing the electrode. This reduces the risks associated with removal and reimplantation of the SCS system.

Epiduroscopically assisted electrode implantation lowers risk of injury to the spinal dura mater injury, epidural bleeding, spinal trauma, and intraoperative pain. In addition, unnecessary stimulation tests or displaced electrodes can be avoided or can enable early recognition of potential high-risk situations.^1,2

23.2 Indications

Difficult SCS electrode implantation can be due to the following:

• Epidural lesion.

• Epidural adhesion.

• Epidural fibrosis.

• Epidural scarring.

• Spinal stenosis

• Postlaminectomy pain or failed back syndrome.

Fig. 23.2 (a) Lateral fluoroscopy demonstrating the stimulator lead position in the epidural space. (b) Anteroposterior fluoroscopy demonstrating the stimulator lead position in the epidural space near midline.