Journal de la colonne vertébrale

Spinal Cord Stimulator Procedure with Intraoperative Neuromonitoring Protocol

Abstract

Nimesha R. Cheruku MBBS, MS, MBA, CNIM*

Spinal Cord Simulators (SCS) are routinely placed in cases medically refractory to pain. Paddle leads are placed under general anesthesia using fluoroscopy and Intraoperative Neuromonitoring (IONM) for midline placement with adequate coverage. After a successful trial of the SCS device with the patient, the implant of paddle leads is ordered for permanent placement in the epidural place under general anesthesia. The leads are implanted based on area of pain, but typically, not proximal to C3-4 levels of the spine. In the case we discuss, our patient was experiencing pain in the shoulders and arms, but additionally had occasional headaches in the occipital region. Therefore, the SCS device was trialed to extend up to the C3-4 levels. Because the patient had a partially successful trail with >50% reduction in pain but remaining headaches, the procedure planned was for placement of permanent paddle leads extending up to the C1-2 levels with Intraoperative Neuromonitoring (IONM).