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Disclosure- none. Madan K. Raj MD., MBA., Neurological Surgery PC, NY. Melzack & Wall. Electric Torpedo Fish. Case History. Spinal Cord Stimulation. A therapy that alleviates pain by sending electrical stimulation via implanted leads to electrodes in the epidural space. Mechanism of SCS.

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  1. Disclosure- none

  2. Madan K. Raj MD., MBA.,Neurological Surgery PC, NY

  3. Melzack & Wall

  4. Electric Torpedo Fish

  5. Case History

  6. Spinal Cord Stimulation

  7. A therapy that alleviates pain by sending electrical stimulation via implanted leads to electrodes in the epidural space

  8. Mechanism of SCS Alters dorsal column chemistry Suppress neuronal hyper-excitablity ^ GABA ^ seretonin release Decrease glutamate, aspartate -----------------------------------------------------Linderoth & Foreman et al

  9. Neurostimulation activates pain-inhibiting neuronal circuits in the dorsal horn and induces a tingling sensation (paraesthesia) that masks the sensations of pain.

  10. Neurostimulation Therapy • Systems have provided chronic pain relief since 1967 • >300,000 people have a Neurostimulation system • Also known as Neuromodulation Therapy • Usually reserved when conservative treatments fail

  11. Implications of Implantables Foreign body Psychologically stable Does not demonstrate drug seeking behavior Needs to understand the technology Needs to understand risks involved

  12. Indications • Failed Back Syndrome • Post Laminectomy pain • Unsuccessful disk surgery • Complex Regional Pain Syndrome (RSD) • Refractory radiculopathy • Arachnoiditis • Painful Neuropathy

  13. Percutaneous

  14. Paddle Leads

  15. Phases • Trial Phase (Test Drive) • Implantation phase

  16. Percutaneous Trial

  17. Precision Plus™ Components Precision IPG and Leads Trial Stimulator Cordless Charger Cordless Patient Remote Navigator Program

  18. Precision PlusTM Permanent SCS System Cordless Charger Implantable Pulse Generator (IPG) Cordless Remote Control Leads

  19. Targets for SCS • C2: Face • C2-4: shoulder to hand • C4-C7: forearm to hand • C7-T1: anterior shoulder • T1-T2: chest wall • T5-T6: abdomen • T7-T9: back • T10-T12: limb • L1: Pelvis, limbs, foot • L5, S1: foot, lower limb • S2-S4: pelvis, rectum • Sacral hiatus: coccyx

  20. Implantation: Pocket Creation and Tunneling

  21. Implantation: Component Connections

  22. Efficacy & Outcomes

  23. Reduced Consumption of Analgesics

  24. Enhanced ADLS

  25. Cost Effectiveness • FBSS : 104 patients • 60 SCS : 44 Non-SCS • Annual cost: 29K : 38K • Work return: 15% : 0% • -----------------------------------------------------Kumar et al Neurosurgery 2002

  26. Benefits of Neurostimulation Improve pain relief Increase activity levels Reduce use of narcotic medications Reversible procedure Minimally Invasive Test drive before Implantation

  27. Advances in SCS • Locking mechanical anchors: Reduced migration • Percutaneous lead introduction arrays: Reduced trauma • Steerable paddle leads: less laminotomy leads • Accelerometer additions: reduced stimulation change with position • MRI compatibility: expanded patient access to care • Dorsal root ganglion stim: specific nerve target, low energy requirement • High freq stim: Pain relief without the need for paresthesis

  28. Summary

  29. PNS • Herpetic Neuralgia • Occipital Neuralgia • Stump Pain • Intercostal Neuralgia • Post Thoracotomy • Painful Neuroma • Migraine

  30. Thank you

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