Subcutaneous stimulation: how to assess optimal implantation depth

Neuromodulation. 2011 Jul-Aug;14(4):343-7; discussion 347-8. doi: 10.1111/j.1525-1403.2011.00357.x. Epub 2011 Apr 15.


Introduction: Subcutaneous stimulation (peripheral nerve field stimulation) is a novel neuromodulation modality that has increased in its utilization during the last 10 years. It consists of introducing a lead in the subdermal level to stimulate the small nerve fibers in that layer. Unlike other neuromodulation techniques including direct peripheral nerve stimulation, spinal cord stimulation, or deep brain stimulation, the precise target is not identified.

Materials and methods: To date, there is no clear guideline on the appropriate depth or a method to achieve reproducibility of the appropriate depth to place these leads. From clinical experience, we have found that when electrodes are placed in a layer that is too superficial, stimulation is often painful or lacks efficacy. Further, if they are too deep, the patient may not feel adequate paresthesia or get uncomfortable stimulation including, in some circumstances, muscle contractions.

Results: In this small series, we demonstrate a novel concept using a radiofrequency stimulation probe to identify the appropriate depth to place the lead. Reproducibility of results will add clarity to the accumulating data and hopefully increase the chances of adequate stimulation coverage and pain relief.

MeSH terms

  • Electric Stimulation Therapy / instrumentation
  • Electric Stimulation Therapy / methods*
  • Electrodes, Implanted*
  • Humans
  • Monitoring, Intraoperative / methods*
  • Pain, Intractable / therapy*