Cervical SCS implant technique/tips

[Tramadeezy]

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Have my first cervical SCS implant coming up soon. Was curious what technique you guys were using for access/IPG placement. Colleague of mine enters at T12/L1 just like lumbar implant and threads long leads all the way up to the C-spine and implants IPG in the flank. Does this technique work well? I have done many lumbar implants so would feel comfortable with this but I'm concerned about getting the leads stuck at the C/T junction. For those of you entering in the C-spine, where is your incision typically located? Are you leaving IPG in the axilla or tunneling all the way down into the lumbar spine with an extension and implanting IPG in the flank? Thanks for any advice.

 

[Tramadeezy]

Anyone...

 

[244913]

Anyone...

I usually enter T3-T5. Make pocket. Thread leads. Tunnel to flank with extensions. I think entering down at 12/1 invites lead migration.

- ex 61N

 

[paindoc007]

Have my first cervical SCS implant coming up soon. Was curious what technique you guys were using for access/IPG placement. Colleague of mine enters at T12/L1 just like lumbar implant and threads long leads all the way up to the C-spine and implants IPG in the flank. Does this technique work well? I have done many lumbar implants so would feel comfortable with this but I'm concerned about getting the leads stuck at the C/T junction. For those of you entering in the C-spine, where is your incision typically located? Are you leaving IPG in the axilla or tunneling all the way down into the lumbar spine with an extension and implanting IPG in the flank? Thanks for any advice.

Typically enter T1-2 or so.
Trick someone taught me, for women ask them where their bra line is. ipg site perfectly fits in there, and more comfortable for them.

 

[lobelsteve]

Typically enter T1-2 or so.
Trick someone taught me, for women ask them where their bra line is. ipg site perfectly fits in there, and more comfortable for them.

Putting an ipg anywhere over ribs is just cruel. Flank is good, axilla if you got the training.

 

[Timeoutofmind]

Putting an ipg anywhere over ribs is just cruel. Flank is good, axilla if you got the training.

What about right below the belt line and a ways off the midline?

 

[lobelsteve]

What about right below the belt line and a ways off the midline?

Yup, to me that means flank. Always below the belt line. Superior gluteals.

 

[Tramadeezy]

Awesome, thanks for the replies. For those using the lumbar extensions, do these need to be anchored as well? Do you place them midline in the L-spine deep like an anchor? Sorry don't have any experience with them... thanks.

 

[unchockey21]

Enter C7-T1 or T1-2. Problem with entering at T12-L1 is you’ll sometimes run into issues advancing leads once you get further up the spine or get bowing. If it’s during the trial, no big deal. Just put needles higher up. If it’s during implant, well now your patient is gonna get an extra incision.

I also tunnel to superior glute. I don’t anchor the extensions. They’re not supposed to be deep. I just put a strain relief loop... and mark your pocket site in preop with the patient sitting up. Everything shifts when they’re prone.