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Neurosurgeons and Pain Physicians: Effective Collaboration
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Neurosurgeons and Pain Physicians: Effective Collaboration. Joshua M. Rosenow, MD, FAANS, FACS Director, Functional Neurosurgery Associate Professor of Neurosurgery, Neurology and Physical Medicine and Rehabilitation Northwestern Memorial Hospital. Neurosurgeons and Pain.
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Neurosurgeons and Pain Physicians: Effective Collaboration
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Neurosurgeons and Pain Physicians: Effective Collaboration
Joshua M. Rosenow, MD, FAANS, FACS
Director, Functional Neurosurgery
Associate Professor of Neurosurgery, Neurology and Physical Medicine and Rehabilitation
Northwestern Memorial Hospital
Neurosurgeons and Pain
- What do we have to offer?
- (besides the capacity to create business for our anesthesia colleagues!)
- On basic level – all neurosurgeons are pain surgeons
- Spinal surgery
- Unique neurosurgical Roles
- Paddle leads
- Certain peripheral procedures
- Craniofacial pain procedures
- Central ablative procedures
Neurosurgical Neurostimulation
- Deep brain stimulation
- Motor cortex stimulation
- Open peripheral nerve stimulation
Peripheral:
Neurectomy
Ganglionectomy
Rhizotomy
Sympathectomy
Spinal cord
DREZ
Cordotomy
Myelotomy
Brain
Medullary tractotomy
Thalamotomy
Cingulotomy
Hypothalamotomy
Cortical excision
Trigeminal Gangliolysis
RF ablation
Glyercol
Balloon compression
Ablative ProceduresNeuromodulation Collaboration
- Communication pre-implant is important
- How did the trial really go?
- Best region of stimulation during the trial?
- Especially important for 16-contact percutaneous lead
- What hardware used for trial?
- What hardware desired for the implant?
- Specific patient factors
- Social
- Psychological
- Physical/Medical
- Insurance
- The referral email is invaluable
Why use paddles?
- Previous difficulties with perc leads
- Preference of implanter
- ?lower current requirement
- ?less interference by epidural fat
Paddle Trial - Unique Neurosurgical Role
- Lumbar fusion or laminectomy precluding percutaneous insertion
- Inability to access the epidural space percutaneously
- Bony anatomy
- Obesity
- Prior procedure in the region of the implant
- Tumor resection, etc.
Collaboration
- Works both directions
- When I refer:
- What do I think is specific diagnosis?
- Why am I really referring the patient?
- Therapeutic procedures
- Diagnostic procedures
- Medical management
- Just don’t know what else to do……
- What specific services am I referring for?
- Do I expect to get the patient back?
- I always leave final discretion to the collaborating physician
Neurosurgeons and Anesthesiologists
- Consultants
- Collaborators
- Co-conspirators
- Our skill sets both overlap and complement each other
