At the risk of getting roasted here by the community I’m posting pics of a retrograde thoracic trial I did. It seems there are enough people here who might get use out of this that I should share. Without going into the full story of how we ended up resorting to this I’ll give a few details. I used a coude needle and still ended up bending it to the shape of a J. I first entered at C7/T1 with the thought of the patients neck being in a flexed position and smaller laminar of C7 would make things easier. Epidural access was easy enough but threading the lead was difficult and was painful for the patient. I ended up being successful at T3/4 surprisingly and had to come in with a paramedian approach. As you can see in the pick with the needle, the angle was still very problematic. It was impossible to get the needle angle any closer to parallel with the canal than what you see in the pic. As such, when threading the lead you can see it really pushed anterior into the cord and was slightly uncomfortable for the patient. (He was awake and no sedation of any kind.) Once the stylet and needle were removed the lead really relaxed and settled in the posterior epidural space nicely. The did really well with the trial and said it cha ged his life, he was extremely greatful, and one of the ones I’ll remeber the rest of my career. He has not been implanted yet, going for paddle placement with a surgeon who I had discussed the case with ahead of time. Happy to answer any questions, I know I sure would have liked to had someone to bounce things off of ahead of time. Everyone I talked to “knew of a guy” who had done it but I think these stories were all rumors. I still haven’t found anyone who knows first hand of someone else having done this in the cervical/high thoracic region. That being said I want to say I think this case was extremely dangerous and would be hard pressed to do it again.
