Percutaneous Peripheral Neuromodulation Lead Insertion Using a Novel Stimulating Coudé Needle

The Neurostimulation Appropriateness Consensus Committee (NACC) Safety Guidelines for the Reduction of Severe Neurological Injury

“…The relatively high incidence of these AEs relates to the fact that most of the current PNS devices were designed for SCS and are used off‐label for PNS. It is likely that devices designed for and dedicated specifically to PNS would have a lower rate of these AEs . In addition, some advances in SCS lead and electrode technology, including a novel MRI‐compatible lead that is powered by wireless radiofrequency technology, allow for an externally worn IPG, obviating the need for an implanted IPG, thus mitigating the risk of lead migration and implanted hardware‐related AEs .…”

Novel Tunneling System for Implantation of Percutaneous Nerve Field Stimulator Electrodes: A Technical Note

“…Once the electrodes are confirmed to be in the appropriate location via test stimulation, intraoperative fluoroscopy, or ultrasound, the sheath can be withdrawn, followed by the electrode stylet (Fig. c–f) . The same sheaths and stylets can be used again to place multiple electrodes.…”

“…Subcutaneous implantation started with tunneling utilizing a curved hemostat . Since that time several percutaneous techniques have evolved, including curved Tuohy needles, IV catheters (Abbocath, Abbott, Dublin, Ireland), and the Epimed Coudé (Lubbock, TX, USA) . The Coudé has been chosen by some implanters, as it allows for improved steering and test stimulation prior to lead implantation .…”

To Test or Not to Test in Peripheral Nerve Stimulation?

“…In the case of external neuromodulation tests being inconclusive, we use direct stimulation (19) with a needle targeted at the nerve, plexus or target/field area using low-frequency stimulation followed by placement of temporary mono leads (Pajunk GmbH, Geisingen, Germany) and trial stimulation for 1-2 weeks (11,20). To simplify the trial and permanent technique further, we have recently developed a stimulating Coudé needle (Epimed, Johnstown, NY, USA) to allow precise introduction of the peripheral neuromodulation lead (1.2 mm) to the desired target (21).…”