The Importance of a Percutaneous Trial of a Spinal Cord Stimulator in a Patient with Extreme Scoliosis

To the Editor,As a technique that relies on anatomical landmarks, percutaneous placement of a spinal cord stimulator (SCS) can be very difficult in patients with scoliosis. This is due not only to the abnormal anatomy of patients with scoliosis, but also to the postoperative changes that occur as a result of corrective procedures. Because of this, surgical placement is often opted for over percutaneous placement. As current literature supports only about a 50–60% success rate in treatment of patients with failed back surgery syndrome (FBBS) [1], we feel that a percutaneous trial placement is a more conservative and subsequently superior modality compared with undergoing surgical placement without trial. A literature search revealed only one case report of percutaneous placement with a case of advanced scoliosis [2]. We present another successful placement and hope to encourage other practitioners to consider a minimally invasive trial prior to scheduling a patient for operative placement.Percutaneous SCS placement has been shown to be a cost-effective technique and is minimally invasive [1,3]. Procedure-related discomfort that may compromise a therapeutic trial is also minimized. Percutaneous electrodes allow longitudinal access to multiple levels via a single interlaminar needle puncture. This facilitates mapping of multiple targets. The use of …