Contralateral and Lateral Views: Analysis of the Technical Aspects of Spinal Cord Stimulator Lead Insertion

Abstract

Background: Spinal cord stimulation (SCS) is an established treatment modality for neuropathic pain. The critical part of this technique is safe access to the epidural space for lead placement. There have been innovations in radiological views, improving access to the epidural space. Objectives: This study analyzes the adoption of these technical advantages in daily practice Methods: We conducted a survey of members in the Spine Intervention Society and American Society of Regional Anesthesia in regard to the practice patterns in SCS therapy. Here we present our findings regarding the use of contralateral oblique (CLO) and lateral views as well direct upper thoracic or cervicothoracic access for SCS lead insertion Results: A total of 195 unique responses were received between March 20, 2020 and June 26, 2020. Forty-five percent of respondents “always used” the lateral view technique while 15% “always used” CLO view for SCS lead insertion. Overall, sixty-five percent of respondents used the CLO view with varying frequency. Cervical and upper thoracic approach for cervical SCS lead placement is always or often used by 66.8% of the respondents. Conclusions: A depth view (CLO or lateral) is always used by only 45 - 60% of the respondents and CLO view has been rapidly adopted in clinical practice for SCS lead insertion. Direct cervicothoracic and upper thoracic is the preferred approach for cervical lead placement by the majority.

The contralateral oblique fluoroscopic view is associated with a lower incidence of postdural puncture headache in patients undergoing percutaneous spinal cord stimulation

“…Additional investigations further validated that this view is efficient and reliable in visualizing the needle tip in relation to the epidural space at T1 with close inter‐observer agreement and little physician instruction 21 . A recent survey of interventional pain physicians found that for epidural access during SCS lead insertion, up to 90% used the lateral view, and 65% used the CLO view 22 . However, a fluoroscopic view to determine needle tip depth, whether lateral or CLO was used by only 45%–60% of respondents during needle placement.…”

“…21 A recent survey of interventional pain physicians found that for epidural access during SCS lead insertion, up to 90% used the lateral view, and 65% used the CLO view. 22 However, a fluoroscopic view to determine needle tip depth, whether lateral or CLO was used by only 45%-60% of respondents during needle placement. The lack of consistent use of fluoroscopy to assess needle depth and the partial adoption of the CLO view may also stem from the lack of "real-world" data that supports that a particular fluoroscopic view may change clinical outcomes.…”

Epidural Catheters for Cervical Epidural Steroid Injections to Target Higher Cervical Pathology: Clinical Images in Practice

“…Lidocaine (5 mm) was injected to provide local anesthetic into the target area before a spine needle was introduced. A contralateral oblique image was utilized for safety and reliability [ 4 , 5 ]. After obtaining a loss of resistance with approximately 3 cm of needle insertion, iohexol contrast without additives was injected and demonstrated minimal cephalic spread (Figure 1 ).…”