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…
Fig. 25.1 Stimulation strategies: tonic stimulation 40 Hz (a); burst stimulation (b) It is important to briefly comment on the mechanism of action, as Burst-SCS appears to work differently than…
Fig. 21.1 Bilateral pelvic stimulation (left) with 3.8-mm quadripolar, selective, cephalocaudal paddles (S1 laminotomy). Distal contacts are anodes at each S2 foramen, and the proximal three contacts are each cathodes….
Fig. 24.1 Radiograph of correct lead placement at vertebral levels T8 to T11, the “sweet spot.” The trial leads can be placed through a needle and then secured to the…
Advancement Current use Future impact Rechargeable IPG Yes Large Enhanced battery life No Important for smaller IPG Different targets Yes Important for DRG-SCS Increased frequency Yes Makes miniaturization difficult Bluetooth…
Patient factor Adverse impact on healing Age Extremes of aged and youth Weight Extremes of obesity and cachexia Nutrition Negative protein balance Blood supply Ischemia and edema Immune function Immunosuppression…
Fig. 4.1 Sagittal T2-weighted MRI of an epidural abscess (arrows, arrowheads) from an SCS trial Systemic infections should be treated and under good control prior to moving forward. If any…
Preoperative Identification of patient risk factors Optimizing immune and nutritional status Optimizing medical comorbidities such as diabetes, immunosuppression, and dental disease Preoperative screening and decolonization for Staphylococcus aureus carriers Appropriate…
High probability Chronic radicular pain Neuropathic pain Peripheral neuropathy Ischemic pain Refractory angina pectoris (not amenable to surgery) Sympathetically mediated pain Peripheral vascular disease Failed Back Surgery Syndrome with radicular…
