Introduction to Screening and Implant Techniques
Screening Test for Neurostimulation
Lead Placement and Intraoperative Test Stimulation
The Clinician’s Role
Screening Test Period

Complete System Implantation

During this phase of the procedure, the physician positions the lead so that the stimulation pattern covers as much of the patient’s pain pattern as possible (Figure 1). The lead is connected to the screener (temporary power source) to enable the implant team to conduct intraoperative test stimulation. The screener is used to set amplitude, pulse width, rate, and lead selections. Each lead can be set at +, -, or OFF which allows for multiple electrode combinations. At least one electrode must be positive and one electrode must be negative. The level of the spinal cord where the negative electrode is located is the primary stimulation level.

Figure 1

As the lead is positioned and electrode selections are changed, the patient provides feedback about the location and intensity of paresthesia. This give-and-take between patient, physician, and other members of the implant team is critical to locating the best lead position and electrode selections for that patient.

The lead should be adjusted so that paresthesia covers the painful area as fully as possible. When optimal coverage is achieved, an x-ray is taken to document the lead tip position.

Note: Some clinicians choose to implant a lead temporarily for the screening test. Those clinicians may use alternate anchoring techniques. Leads implanted using a temporary implantation protocol are typically removed within 10 days.

After intraoperative test stimulation, the physician places a temporary extension for a screening test period. The percutaneous extension wire is taped in place, and sterile dressings are applied. All settings are carefully documented by the clinician in the proper assessment form.

The patient then continues to test the efficacy of neurostimulation during a screening test period. If the stimulation achieved is unsatisfactory to the patient during the procedure itself and the patient does not wish to continue, the temporary screening lead is removed, and the patient can be evaluated for other therapies.

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Introduction to Screening and Implant Techniques
Screening Test for Neurostimulation
Lead Placement and Intraoperative Test Stimulation
The Clinician’s Role
Screening Test Period

Complete System Implantation