RT Book, Section A1 Bedder, Marshall D. A2 Diwan, Sudhir A2 Staats, Peter S. SR Print(0) ID 1107200397 T1 Anterograde Versus Retrograde Lead Placement T2 Atlas of Pain Medicine Procedures YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 9780071738767 LK accessanesthesiology.mhmedical.com/content.aspx?aid=1107200397 RD 2024/03/28 AB The discussion for an anterograde approach versus a retrograde approach to lead placement for spinal cord stimulation (SCS) has evolved in relationship to optimal coverage for pelvic pain conditions. Early attempts to treat bladder pain focused on retrograde placement of SCS leads to the S3 foramen. Unfamiliarity of many practitioners with this technique, the more difficult technical aspects, and the variable anatomy of the sacrum have all posed challenges to this approach. Anterograde placement with lead positioning at the T10-T12 levels has shown great promise in pelvic pain structure coverage. It is now known that retrograde placement is actually a peripheral nerve stimulation performed within the spinal canal by stimulating specific sacral nerves. Whereas anterograde placement is true spinal cord stimulation giving rise to stimulation paresthesia not only in the pelvic distribution but also in the lower extremities. Anterograde stimulation produces an electrical field at the spinal cord activating all known mechanisms of action, whereas it is highly unlikely that peripheral nerve stimulation activates as many different mechanisms of action.