Schade, C.M., M.D., Ph.D., P.E., Law, J.D., M.D., Meril, A.J., M.D. Guidelines for Implantation of a Percutaneous Spinal Cord Stimulator, Neuromed, Inc., 1993.
The purpose of this monograph is to provide a “cookbook” for the novice or beginning implanter and possibly a “pearl or two” for the experienced implanter. In the interest of brevity, only the percutaneous placement of the Neuromed Octrode® lead for failed back surgery syndrome will be discussed. However, be aware that in some cases (i.e .. spinal stenosis, epidural scarring, repeat procedures) the percutaneous technique may not be successful and a mini-laminotomy will be needed to place a Lamitrode®, Peritrode, Quattrode, or Octrode® lead. The physiological basis for the clinical effects of spinal cord stimulation is still unclear. A popular hypothesis is that the mechanism of action of a spinal cord stimulator involves the Melzack-Wall gate control theory of pain (1). Spinal cord stimulation may work by stimulating the axons in the dorsal column of the spinal cord.
The objective in electrode placement is to activate these nerves at a convenient anatomical location. At the periphery, you can obviously stimulate only a single nerve, while at the level of the second cervical vertebral body you can stimulate many different nerve tracts and fibers. It has been shown by exhaustive mapping and analysis of data that the average location for the so called “Sweet Spot” for low back stimulation is located at a point about half way between the inferior border of the pedicals of T9 and T I o.m Locating the “Sweet Spot” is made easier if you conceptually visualize the nerve fibers entering the dorsal column and becoming smaller, moving medially and ventrally as they ascend the spinal cord. Spinal cord stimulation is effective in treating chronic pain in carefully selected patients. Proper patient selection will improve any clinical results- short and long term.