Minimum space for SCS perc lead?

[Timeoutofmind]

---

Members do not see this ad.

I have read that 14mm AP spinal canal diameter is a relative contraindication and 10 mm is an absolute contraindication for thoracic and cervical spines for lead placement.
Is this what you guys use?
I asked around and it seems like a lot of people just sort of eyeball the MRI and see if they can see more than a smidge of epidural space there and if they can they are good to go?
Any experiences on this board with placing them in some tighter spaces and what the results were? I have more than one patient who is not a surgical candidate with cervical radicular pain who failed everything conservative with canal diameters of 8 or 9 mm or so...

 

[lobelsteve]

Less than 11 and you better not have a bad outcome. But if tiny cord and 2mm csf, would consider.

8-9mm is contraindicated.

 

[ateria radicularis magna]

Less than 11 and you better not have a bad outcome. But if tiny cord and 2mm csf, would consider.

8-9mm is contraindicated.

Do you always get thoracic MRI prior to SCS trial?

 

[lobelsteve]

Do you always get thoracic MRI prior to SCS trial?

Rarely. I can see to top of T9 in most of the lumbar series I get.

 

[bedrock]

Do you always get thoracic MRI prior to SCS trial?

Yes. If you search this forum, you'll read about why. The last thing you want is a preventable complication.

 

[Spartanes24]

Any of you have sources regarding spinal canal diameter and placement of perc leads? I haven’t been able to find the numbers you guys quoted.

 

[Gnarvin]

I was taught that as long as there is CSF present in the imaging all the way around the cord that you are ok.

 

[Espn123]

Rarely. I can see to top of T9 in most of the lumbar series I get.

you don’t ever put a thoracic lead higher than that? Seems like the same reasoning of you better not have a bad outcome would apply if skipping a T MRI...

 

[lobelsteve]

you don’t ever put a thoracic lead higher than that? Seems like the same reasoning of you better not have a bad outcome would apply if skipping a T MRI...

Nope. Spanning T9-10 and T10-11. As long as I can see that disc space I am comfortable. Most of my SCS comes on implants with trials done by other pain docs.

 

[paindoc007]

I’m the same way as Steve. My mid sag lumbar mri gets to T9 or so. And I typically get leads to t8. So I don’t really feel I’m being a cowboy not getting a dedicated thoracic mri.