PMC10316136_01
Fluoroscopy view of the percutaneous thoracic spine needle access (a); later the eight contact lead (dashed line), partially in the epidural space on anterior-posterior view (b); and lateral view (c) showing entire lead (dashed line image) within the thoracic epidural space.
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F1
Under general anesthesia, the patient was placed in the prone position and fluoroscopy was used to identify the level of the thoracic entry point on the skin (T6) of the Tuohy needle and in the epidural space in T4 [Figure 1].
Lateral fluoroscopy view after the placement of the spinal cord stimulation (SCS) trial electrode (dashed line image), advanced to the upper cervical spine just below posterior arc of C1 level in the dorsal epidural space (a); Anterior-posterior fluoroscopy view showing the electrode (dashed line image) towards right side of the epidural space in the upper cervical spine (b).
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F2
Then, X-rays were taken to determine the level of placement if the trial surgery was successful [Figure 2].
PMC10316136_02
Spinal cord stimulation trial lead placement with Tuohy needle inserted at level T3-4 (a), and advancement of the eight contact lead (dashed line image) on anterior-posterior fluoroscopy view from cervical level C2 to C4 (b).
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F3
From this point on, the percutaneous SCS lead advanced to the level of C2-C4 that has resistance to further advancement [Figure 3].
Lateral fluoroscopy view of the placement of the spinal cord stimulator lead (dashed line image) with upper contact between cervical level C1-C2 (a); on anterior-posterior view, the tip of the eight contact percutaneous lead (dashed line image) is directed to patient's right side (b).
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F4
With the success of the trial procedure, the patient was then readmitted to the OR replicating the initial trial procedure [Figure 4], placing an eight contact lead which was anchored to the thoracic fascia and tunneled to the right flank as described on the previous patient for battery implantation (Medtronic 97715 Stim Medt Nerve Intellis) [Figure 5].
Placement of the battery for the spinal cord stimulation lead in the right lower lumbar region.
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F5
With the success of the trial procedure, the patient was then readmitted to the OR replicating the initial trial procedure [Figure 4], placing an eight contact lead which was anchored to the thoracic fascia and tunneled to the right flank as described on the previous patient for battery implantation (Medtronic 97715 Stim Medt Nerve Intellis) [Figure 5].