Cervical Spinal Cord Stimulation

Chapter 30 Cervical Spinal Cord Stimulation



Ruby E. Kim, Michael B. Furman


Note: Please see page ii for a list of anatomical terms/abbreviations used in this book.


Spinal cord stimulation is typically used as a “last resort” for patients who no longer have any other treatment options. It is typically used for patients who have had prior cervical surgery. It is best for patients with a larger component of appendicular as opposed to axial pain. Other indications include complex regional pain syndrome. In Europe, spinal cord stimulation has been described for the treatment of vascular claudication and angina.


The technique described in this chapter follows the algorithm described elsewhere in this book. In particular, we use a trajectory view to identify the oblique and tilt angle (i.e., the entry point) for the placement of the needle. Note that the angle of the needle is as shallow as possible so that the stimulator lead will smoothly exit the needle into the posterior epidural space riding along the patient’s midline until the active electrodes reach the level at which the patient’s pain symptoms are covered, which is often between C4 and C6. To obtain that smooth exit, the needle needs to have a shallow angle relative to the patient (i.e., to be as parallel to the patient’s body as possible). Because we are using trajectory, contralateral oblique, and lateral safety views, it is not necessary to step off of the lamina with the following described technique.


Access to the cervical interlaminar space may be obtained from between C7-T1 through T2-T3.



image Trajectory View (Figure 30–1)




image Confirm the appropriate interlaminar space with the anteroposterior view. (We demonstrate T1-2 here.)


image Maintain your marker at the appropriate interlaminar space and tilt the C-arm image intensifier as caudally as possible to obtain the trajectory view.


image Slightly oblique the C-arm contralateral to the symptomatic side so that the introducer will be set up to help guide the stimulator lead. The lead will have a tendency to travel contralateral to the side of entry, thereby making this technique an efficient method for facilitating proper lead positioning.


image Anesthetize the skin over the interlaminar space (T1-2 demonstrated here), and use an 18-gauge, 1.5 inch needle to dilate the skin.


image Remove the 18-gauge needle, and use the introducer needle to obtain the trajectory needle view.


image Because this is the trajectory view, the needle entry position should be parallel to the C-arm beam.


image Note that the angle of the needle is as shallow as possible, as described in this chapter’s introduction.

Related posts:

Atlantoaxial Joint Intraarticular Injection Thoracic Zygapophysial Joint Intraarticular Injection, Posterior Approach Thoracic Transforaminal Epidural Steroid Injection, Infraneural Approach Cervical Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy and Nerve Injection, Posterior Approach Thoracic Interlaminar Epidural Steroid Injection, Paramedian Approach Cervical Discography/Disc Access

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Dec 23, 2015 | Posted by in INTERVENTIONAL RADIOLOGY | Comments Off on Cervical Spinal Cord Stimulation

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