DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in the prone position. The pressure points were checked and padded, and routine monitors were placed. Adequate MAC anesthesia was applied. The patient was prepped and draped in a sterile fashion. The L1-2 interspace was located by fluoroscopy. Lidocaine 1% was used for skin anesthesia. A 14-gauge Tuohy spinal cord stimulator was placed through a right primary approach at L1-2 interspace in the mass of the ligamentum flavum. Epidural space was located using loss of air technique. Needle was checked on AP and lateral fluoroscopy. Negative CSF, heme, paresthesia obtained. Spinal cord stimulator electrode was threaded through the catheter in the epidural space without difficulty. The spinal cord stimulator electrode would advance approximately 1-1/2 interspaces and then would not advance further. There appeared to be possibly some scar tissue at this area. Thus, T12-L1 interspace was located. Lidocaine 1% was again used for skin anesthesia. A 15 blade was used to make a skin nick and a 14-gauge Tuohy spinal cord stimulator needle was placed through the skin nick though a right paramedian approach at the T12-L1 interspace, advanced to the ligamentum flavum. Epidural space located using loss of air technique. Negative CSF, heme, paresthesia obtained. Needle tip was checked on AP and lateral views fluoroscopically. The spinal cord stimulator electrode was placed though the needle into the epidural space and advanced under fluoroscopic guidance. The tip could be advanced in the right midline up to approximately the bottom of the T10 vertebra; it would not advance any further than that. Care was taken with multiple attempts, but it wound not advance. Thus, it was left in the tip at the bottom of T10 in the midline and the patient's anesthesia was allowed to be reversed. She was awake and alert. The stimulator was stimulated with multiple electrode settings and had excellent stimulation that covered her low back, right lower extremity pain, from her back to her foot with multiple electrode combinations. Thus, the stylet was removed from the needle. The needle was removed tip intact, taking care not to dislodge the spinal cord stimulator electrode. The anchor was placed over the electrode until it was flush with the skin and clamped in place. Three 2-0 Ethibond sutures were placed around the anchor to secure it to the skin. Sterile dressings were applied. The patient tolerated the procedure well and had excellent range of motion of lower extremities upon completion of the procedure.
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