Sau khi khu vực đau đớn là "bắt", hoặc với một hoặc hai nhân vật chính, hai kỹ thuật phân kỳ. Trong thử nghiệm trực tiếp qua da, kim được rút ra, một khâu neo đậu được đặt vào da, và một mặc quần áo vô trùng được áp dụng. | 7-4 Neuroengineering a b FIGURE Percutaneous lead placement a marking the interspinous level b percutaneous lead insertion and c dual lead trial. Courtesy of Medtronic Inc. electrically induced paresthesia. After the painful area is captured either with one or two leads the two techniques diverge. In the straight percutaneous trial the needle is withdrawn an anchoring suture is placed into the skin and a sterile dressing is applied. When the patient returns after a several-day trial the dressing is removed suture clipped lead removed and discarded regardless of the success of the trial. When the patient returns for implant a new lead is placed in the location of the trial lead and connected to an implanted IPG. Spinal Cord Stimulation for Pain Management 7-5 FIGURE continued FIGURE Anchoring the lead. Courtesy of Medtronic Inc. In the implanted lead trial after successful positioning of the trial leads local anesthesia is infiltrated around the needles and an incision is made cutting down to the supraspinous fascia to anchor the leads securely using nonabsorbable sutures Figure . Then a temporary extension piece is tunneled away from the back incision and out through the skin. This exiting percutaneous extension piece is secured to the skin using a suture with antibiotic ointment and a sterile dressing subsequently applied. If the trial is successful then at the time of implant the back incision is opened the percutaneous extension piece is cut pulled out through the skin site and discarded. The permanent leads that were used for the trial are hooked to new extensions and tunneled to an implanted IPG. The implanted lead method has the advantages of saving the cost of new electrodes at implant and ensuring that the implanted lead position matches the trial lead position. Advantages of the 7-6 Neuroengineering percutaneous lead approach include avoiding the costs of two trips to the operating room even for an unsuccessful trial to remove the anchored
