• Jie Zhu, Frank J E Falco, C Obi Onyewu, Renato Vesga, Youssef Josephson, Asim Husain, and Gabriella Gutman.
• Mid Atlantic Spine & Pain Physicians, Newark, DE, USA. zzzzjim@gmail.com
• Pain Physician. 2011 Mar 1;14(2):195-210.

BackgroundNeuromodulation with spinal cord stimulation is a proven cost effective treatment for the management of common conditions such as chronic radicular leg pain from failed back surgery syndrome, complex regional pain syndrome, and other painful neuropathic pain syndromes. The traditionally instructed method for percutaneous spinal cord stimulator (SCS) lead placement promotes the use of a "loss of resistance" (LOR) technique under anteroposterior (AP) fluoroscopic guidance to assure midline lead placement and proper entry into the epidural space.ObjectiveTo describe the relevant anatomy and method for a precise needle placement approach for placement of percutaneous cervical spinal cord stimulation (SCS) leads without loss of resistance (LOR) using a syringe. An oblique fluoroscopic view is presented demonstrating successful placement of cervical SCS leads.DesignTechnical report.SettingPain management clinic.MethodsDiscussion with accompanying fluoroscopic images. This technical report meets HIPAA compliance standards.ResultsSuccessful placement of percutaneous SCS leads without traditional loss of resistance using an oblique fluoroscopic approach.LimitationsTechnical report only. The risks, potential complications, and benefit from this approach are beyond the scope of the article.ConclusionsThis fluoroscopic technique provides an alternative means for placing percutaneous cervical SCS leads without the use of the traditional loss of resistance technique.

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