Spinal cord stimulation was previously used as a “last resort” for patients who no longer had any other treatment options; however, it should be considered sooner in the treatment armamentarium. It is typically used for patients who have undergone prior cervical surgery with continuous upper limb radicular pain or for patients with upper limb complex regional pain syndrome. It is best advised for patients with more appendicular pain as opposed to axial pain. In Europe, spinal cord stimulation has been described for the treatment of vascular claudication and angina.

The technique described in this chapter follows the algorithm described elsewhere in this book. In particular, we use a trajectory view to identify the oblique and tilt angle (i.e., the entry point) for needle placement. Note that the needle entry angle is as shallow as possible so that the stimulator lead will smoothly exit the needle into the posterior epidural space, passing along the patient’s midline until the active electrodes reach the level at which the patient’s pain symptoms are covered, which is often at the upper cervical levels, as high as C2. To obtain that smooth exit, the introducer needle should have a shallow angle trajectory relative to the patient (i.e., to be as parallel to the patient’s body as possible). Because we are using the trajectory, contralateral oblique (CLO), and lateral safety views, it is not necessary to step off the lamina with the following described technique.

Access to the cervical dorsal epidural space may be obtained with interlaminar access, entering at levels between C7-T1 and T2-T3.