This is a 68 year old woman with history of C2-C7 laminectomy and fusion. She had painful C2-3 radicular pain but an anterograde trial was unsuccessful as the lead could not be advanced through the scar. With a complete laminectomy there is such extensive scar tissue it is impossible to advance a lead in standard fashion.
The red line demonstates the scar tissue from previous laminectomy. You can also see the paraspinous muscle atrophy. The inferior portion of the skull is also visible as it the existing hardware. I performed a suboccipital exposure under local MAC anesthesia and fed two percutaneous leads in via a retrograde fashion.