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Trolling the sweet spot – back pain without leg pain

This is a 58 year old man who had a L4-5 fusion for mobile spondylolisthesis with marked improvement in his low back and leg pain, but had persistent midback pain.

 

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Mid back coverage without getting legs is somewhat difficult.  I typically start at T6-7 and retreat the lead, but in this case the coverage was lower than expected.

Trolling the sweet spot

The 16 contact Infinion™ by Boston Scientific allows you to troll the spinal cord after implant to better isolate the sweet spot.  As with all of my cases, I have my rep mark the sweet spot for final implantation.

splitter

The downside is somewhat awkward splitter that divides the 16 contact lead into two octrodes that fit in an external IPG.  As shown here, the Infinion™ trial lead only comes in 50cm lengths.  I prefer the longer 70cm length to get the splitter off the midline and over the flank for a more comfortable trial.  You have to use a 70cm permanent lead as a trial to do this.

final

As a trialing lead this gives you the optimum level for permanent implantation.