Peripheral Nerve Stimulation: Fluoroscopic Implant Techniques

Although peripheral neuromodulation devices have been utilized as far back as the 1960s following the pioneering work of Wall and Sweet, it was not until the late 1990s that less invasive, percutaneous techniques were introduced. These minimally invasive techniques brought forth an expanse of utilization for peripheral nerve stimulation (PNS) as implantation was no longer restricted to peripheral nerve surgeons but could also be performed by anesthesiologists and physiatrists. Given the low invasiveness of these procedures, reliance is placed almost entirely on intraoperative imaging to guide lead placement in real time. Both intraoperative fluoroscopy and ultrasound have proven to be crucial adjuncts in the placement of percutaneous PNS electrodes. In this chapter, we focus on procedural details of PNS lead implantation where intraoperative fluoroscopy is used for surgical targeting while highlighting the specific workflows for the placement of these electrodes.