Combined epidural and peripheral nerve stimulation for relief of pain. Description of technique and preliminary results.

A technique is described that combines percutaneous epidural with peripheral nerve stimulation to provide limited paresthesia to a lower extremity. The peripheral electrode is placed percutaneously and positioned along the course of the anterior division fo the spinal nerve anterolateral to the vertebral bodies. This is accomplished by a modified epidural tap. Combined stimulation was carried out in 23 patients with intractable leg pain. Sixteen patients proceeded to chronic autostimulation; follow-up time extended to 18 months. The procedure proved simple; there were no perioperative and only few minor late complications. Results were similar to those from conventional epidural stimulator implantation. It is concluded that combined epidural-peripheral nerve stimulation constitutes a valid therapeutic alternative for patients with unilateral lower extremity pain.