Neuromodulation in Practice: Peripheral Nerve Stimulation-Sciatic & Tibial Nerve Targets

Video Transcription

Video Summary

Scott Pritzlaff (UC Davis) reviews peripheral nerve stimulation (PNS) targeting the sciatic and tibial nerves for lower-extremity neuropathic pain, with evidence in complex regional pain syndrome and post-amputation pain. He notes PNS can be a lower-risk alternative for patients unsuitable for dorsal root ganglion or spinal cord stimulation (e.g., prior complex spine surgery or anticoagulation). Planning depends on pain distribution and where the patient will wear the external power unit; targets include the popliteal fossa (sciatic or tibial) and the tarsal tunnel (posterior tibial) for foot/plantar pain.<br /><br />Using ultrasound, he demonstrates sciatic lead placement in the popliteal fossa with perpendicular and parallel (“follow-me”) approaches, emphasizing avoiding epineurium violation, placing 4–5 cm of lead to reduce migration, and testing for sensory capture while minimizing motor activation. For infection prevention, he uses a pre-implant cephalosporin dose and careful tunneling plans. For tibial PNS, he shows popliteal placement and a tarsal tunnel technique, distinguishing tendons from nerve via anisotropy and avoiding tunneling across major joints (knee) to limit migration.

Keywords

peripheral nerve stimulation

sciatic nerve

tibial nerve

lower-extremity neuropathic pain

ultrasound-guided lead placement

complex regional pain syndrome