![]() However, there are reports in the literature of this procedure being done under conscious sedation with good results. Epidural spinal cord stimulation with a multiple electrode paddle lead is effective in treating intractable low back pain. The authors perform the procedure under general anesthesia with the head stabilized in a Mayfield head frame so as to obtain maximum flexion and temporary reversal of the cervical lordosis. The authors always obtain an MRI prior to paddle implant in order to assess canal diameter so an appropriately sized paddle may be selected. Additionally, preoperative imaging with cervical MRI is more critical in this region leading some authors to uniformly recommend it preoperatively. Unsurprisingly, there is reportedly a higher rate of lead migration in the cervical spine than the thoracic spine. However, some authors’ enthusiasm for cervical spinal cord stimulation is tempered by the challenge of securing an electrode in this inherently more flexible region. In order to obtain coverage in the neck and upper extremity, an upper cervical vertebral body is typically targeted. Some patients may need an open procedure requiring laminectomy to place the electrodes. The neurostimulator electrodes used for this purpose are implanted percutaneously in the epidural space through a special needle. Neuromodulation via cervical stimulation is often utilized to control neck and upper extremity pain. Two persons with a motor complete (AIS B) SCI and a neurological level of injury of C5 and C6, respectively, received a 16-electrode array implanted epidurally from C5 to T1 level and connected to a spinal cord stimulator (Boston Scientific, Marlborough, MA, USA) with the primary aim to treat a refractory chronic pain condition. Spinal cord stimulation blocks pain conduction pathways to the brain and may stimulate endorphins.
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