Surgeon prefers paddle lead Surgeon not skilled in percutaneous technique Difficult needle access to the spine because of anatomical characteristics Epidural fibrosis Revision because of lead migration Inadequate power with…
1. Understand the anatomy at the location of planned needle entry 2. Review the skin integrity for lesions or local infection 3. Review recent plain films if there is concern…
Fig. 19.1 The postsynaptic dorsal column pathway. Importantly, these fibers ascend ipsilaterally within the spinal cord Divergently, the somatic nerves that supply the abdominal wall have primary afferents within the…
Fig. 28.1 Ulnar nerve course in the distal and proximal upper extremity A possible location for stimulation of radial and median nerves in the forearm for treatment of hand pain…
Cathode placement Stimulation target Cervical C2 Face, below the maxillary region C2–C4 Neck, and shoulder to hand C4–C7 Forearm to hand C7–T1 Anterior shoulder Thoracic T1–T2 Chest wall T5–T6 Abdomen…
More conservative treatment options have failed, or other options are unacceptable or not indicated. A trial of neuraxial medications provides acceptable pain relief, tolerable side effects, and functional improvement, when…
Agent Starting dose Morphine 0.1–0.5 mg/day Hydromorphone 0.02–0.5 mg/day Fentanyl 25–75 μg/day Bupivacaine 1–4 mg/day Clonidine 40–100 μg/day Ziconotide 0.5–2.4 μg/day From Deer et al. (2012) with permission Table 41.2…
Fig. 32.1 Frame-based stereotactic guidance for deep brain lead placement (left). Frameless stereotactic guidance for deep brain lead placement (right) Stereotactic localization of bilateral entry points is performed and these…
Year Milestone 1885 Leonard Corning administers neuraxial local anesthetic 1901 Intraspinal morphine use is first reported 1935 Dr. Grafton Love first proposes continuous catheter access 1940 The first practical application…
Fig. 20.1 Intraoperative view of thoracic paddle lead implantation. (a) The electrode is behind the body of T9 and T10. Stimulation is right sided with the cathode at the second…
