What fluoroscopy techniques should be used to avoid the incidence of undesirable paresthesia during lead implantation and test stimulation?
Fluoroscopy itself does not prevent the occurrence of undesirable paresthesia during lead implantation and test stimulation, but it facilitates good lead placement to minimise the occurrence of such problems. Most uncomfortable paresthesia locations are due to being in the ventral epidural space, lateral in the posterior epidural space, or sub-dural. Appropriate fluoroscopic technique, contrast, and anatomic knowledge can help avoid such placement. A key to effective use of fluoroscopy is to minimize parallax error, which causes misrepresentation of locations of the stimulation lead and anatomic landmarks. Keep the fluoroscopy machine centered over the patient and the stimulation electrode. When viewing the AP fluoroscopy image, be sure the spinous processes are centered as close as possible between the pedicles on each side, and be sure the fluoroscopy unit is centered over the contacts of the lead. Proper centering of the fluoroscopy unit over the lead and patient facilitates placeme
