title: Alternative approach to needle placement in cervical spinal cord stimulator insertion.
abstract: BACKGROUND
  Neuromodulation with spinal cord stimulation is a proven cost effective treatment for the management of common conditions such as chronic radicular leg pain from failed back surgery syndrome, complex regional pain syndrome, and other painful neuropathic pain syndromes. The traditionally instructed method for percutaneous spinal cord stimulator (SCS) lead placement promotes the use of a "loss of resistance" (LOR) technique under anteroposterior (AP) fluoroscopic guidance to assure midline lead placement and proper entry into the epidural space.
  
  
  OBJECTIVE
  To describe the relevant anatomy and method for a precise needle placement approach for placement of percutaneous cervical spinal cord stimulation (SCS) leads without loss of resistance (LOR) using a syringe. An oblique fluoroscopic view is presented demonstrating successful placement of cervical SCS leads.
  
  
  METHODS
  Technical report.
  
  
  METHODS
  Pain management clinic.
  
  
  METHODS
  Discussion with accompanying fluoroscopic images. This technical report meets HIPAA compliance standards.
  
  
  RESULTS
  Successful placement of percutaneous SCS leads without traditional loss of resistance using an oblique fluoroscopic approach.
  
  
  CONCLUSIONS
  Technical report only. The risks, potential complications, and benefit from this approach are beyond the scope of the article.
  
  
  CONCLUSIONS
  This fluoroscopic technique provides an alternative means for placing percutaneous cervical SCS leads without the use of the traditional loss of resistance technique.
authors.affiliation: Mid Atlantic Spine & Pain Physicians, Newark, DE, USA. zzzzjim@gmail.com
authors.forename: Jie
authors.initials: J
authors.lastname: Zhu
authors.forename: Frank J E
authors.initials: FJ
authors.lastname: Falco
authors.forename: C Obi
authors.initials: CO
authors.lastname: Onyewu
authors.forename: Renato
authors.initials: R
authors.lastname: Vesga
authors.forename: Youssef
authors.initials: Y
authors.lastname: Josephson
authors.forename: Asim
authors.initials: A
authors.lastname: Husain
authors.forename: Gabriella
authors.initials: G
authors.lastname: Gutman
mesh_terms: D002574:Cervical Vertebrae; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D006801:Humans; D009437:Neuralgia / Q000628:therapy*; D013116:Spinal Cord / Q000601:surgery*