Figure 1834

Percutaneous discectomy, lumbar, anteroposte-rior view after contrast injection.

FIGURE 18 35 Percutanous lead for spinal cord stimu-

^ lation of a unilateral neuropathic lower

Percutaneous discectomy, lumbar, anteroposte-

FIGURE 18 35 Percutanous lead for spinal cord stimu-

^ lation of a unilateral neuropathic lower

Percutaneous discectomy, lumbar, anteroposte-

limb, anteroposterior view.

rior view after contrast injection.

Procedure Under local anesthesia and conscious sedation a percutaneous lead is introduced via a Touhy-type spinal needle into the epidural space and advanced to the spinal cord level corresponding to the neuropathic nerve. When the lead is in place a stimulation trial is performed and the lead is adjusted to obtain maximum pain relief. The percutaneous lead is attached to an external stimulator and the patient usually goes home for few days to try the system during his routine daily activities. About a week later the percutaneous lead is removed. After waiting at least another week the permanent system is implanted if the patient liked the pain relief obtained during the trial and there was more than 50% decrease of the pain or consumption of pain medications. See Figures 18-36 and 18-37.

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