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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

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
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
Neurosurgical Neurostimulation
  • Deep brain stimulation
  • Motor cortex stimulation
  • Open peripheral nerve stimulation
ablative procedures
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 Procedures
neuromodulation collaboration
Neuromodulation 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
paddle leads
why use paddles
Why use paddles?
  • Previous difficulties with perc leads
  • Preference of implanter
  • ?lower current requirement
  • ?less interference by epidural fat
paddle trial unique neurosurgical role
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.
guess the level
communication is key
collaboration
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
Neurosurgeons and Anesthesiologists
  • Consultants
  • Collaborators
  • Co-conspirators
  • Our skill sets both overlap and complement each other
slide13

Thank you for coming!

E-mail: jrosenow@nmff.org

Phone: 312-695-0495