Mid Atlantic Spine & Pain Physicians, Newark, NJ, USA.
Pain Physician. 2011 Jan-Feb;14(1):45-53.
Neuromodulation with spinal cord stimulation is a proven, cost effective treatment for the management of chronic radicular low back pain from failed low back surgery syndrome and other neuropathic pain conditions. The traditionally instructed method for percutaneous spinal cord stimulator lead placement promotes the use of a "loss of resistance" technique under anteroposterior fluoroscopic guidance to assure midline lead placement and proper entry into the epidural space. Loss of resistance is a reliable method to locate the epidural space in most clinical situations. However, in certain circumstances such as a congenital underdeveloped ligamentum flavum or defects of the ligamentum flavum, sometimes occurring after lumbar spine surgery, it might become difficult to use a loss of resistance technique to locate the epidural space. In this case, the level of resistance might not be clear. Further, a false loss of resistance might occur between changes in fascial planes that might lead to the uncertainty of needle depth. This paper introduces an alternative method for needle placement for spinal cord stimulator (SCS) trials and implantation without using the traditional loss of resistance technique. The technique allows for precise visual monitoring of the Tuohy needle tip under fluoroscopy to gauge needle depth as it enters into the tissue and the epidural space based on anatomic structural landmarks. This method allows for multiple lead placement or single lead insertion multiple times in the same interlaminar space. This is an alternative approach to the loss of resistance technique based on the fluoroscopic landmarks. Theoretically, this should be a safer approach for accessing the epidural space; however, further studies are needed to evaluate its safety.
脊髓刺激的神经调节是一种经过验证的、具有成本效益的治疗方法，可用于治疗失败性腰椎手术综合征和其他神经病理性疼痛病症引起的慢性神经根性下腰痛。传统的经皮脊髓刺激器导线放置方法是在前后透视引导下使用“阻力消失”技术，以确保导线位于中线位置并正确进入硬膜外腔。阻力消失是在大多数临床情况下定位硬膜外腔的可靠方法。然而，在某些情况下，如先天性黄韧带发育不良或黄韧带缺陷（有时发生在腰椎手术后），使用阻力消失技术可能难以定位硬膜外腔。在这种情况下，阻力可能不明显。此外，筋膜平面之间的假阻力消失可能导致针深度不确定。本文介绍了一种替代方法，用于在不使用传统阻力消失技术的情况下进行脊髓刺激器（SCS）试验和植入的针放置。该技术允许在透视下精确监测 Tuohy 针尖，根据解剖结构标志测量针尖进入组织和硬膜外腔的深度。该方法允许在同一层间空间中多次放置多个导线或单次插入多个导线。这是一种基于透视标志的阻力消失技术的替代方法。理论上，这是一种进入硬膜外腔的更安全方法；然而，需要进一步的研究来评估其安全性。
