Indications
- •
Nerve root injury with radicular pain in the absence of compressive pathology
- •
Nerve root injury as a complication of spine surgery, including nerve root retraction or injury secondary to interbody graft placement or pedicle screw fixation
- •
Painful peripheral neuropathy refractory to medical management
Contraindications
- •
Thoracic spinal stenosis at the level of lead placement
- •
Reversible compressive lesion (e.g., disk herniation, synovial cyst) accounting for the patient’s neurologic complaints
- •
Previous thoracic laminectomy with scar tissue in the epidural space at the level of lead placement
- •
Active systemic infection or medical contraindication to surgery
Planning and positioning
- •
The patient should have a percutaneous spinal cord stimulator trial that shows good pain coverage before permanent implantation.
- •
The gluteal incision for battery insertion should be placed 2 fingerbreadths below the iliac crest (i.e., below patient’s belt line) and just lateral to the sacrum on the side opposite of the patient’s preferred side of sleep.
- •
Anteroposterior fluoroscopy should be positioned so that the pedicles are symmetric and are bisected by the corresponding spinous processes, verifying that fluoroscopic images are perpendicular to the patient’s spine at the operative level.
Figure 90-1:
In the preoperative area, the patient’s back is palpated in the upright position to plan the ideal location for battery placement.
Figure 90-2:
The patient is intubated and positioned prone on a Jackson table with appropriate padding of all dependent surfaces to avoid pressure-related tissue necrosis or peripheral nerve injury. Fluoroscopy C-arm is used to plan the vertical midline spinal incision over the T9-10 interspace.
Figure 90-3:
The surgical field, including the thoracic and gluteal incisions, is prepared and draped in the standard sterile fashion. Preoperative antibiotics are given before the skin incision.
Procedure
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
