Spinal Cord Stimulation

Publisher Summary This chapter describes the surgical technique of implanting electrodes for spinal cord stimulation and outline the advantages and disadvantages of the types of anesthesia that can be utilized. The placement of surgical leads via laminotomy is a safe and effective procedure and is gaining popularity amongst implanters of SCS. There is approximately only 1.5 V difference when comparing the intraoperative and postoperative testing. The choice of anesthesia is largely driven by the surgeon's experience, his or her comfort level, and patient choice. Spinal anesthesia allows proper placement with the guidance of stimulation-induced paresthesia and eliminates the need for somatosensory evoked potentials. Spinal anesthesia does not block all sensory transmission in the superficial layers of the spinal dorsal columns, thus permitting intraoperative testing and proper lead positioning. The subarachnoid anesthetic agents act mostly on spinal rootlets and perhaps the ganglia, and the spinal afferent pathways remain unaffected. It is technically easy on the patient and the surgeon when compared with local anesthesia.