SCS implant - GA with electrophysiologic monitoring

[NJPAIN]

Any of you guys doing your SCS implants under GA with electrophysiologic monitoring and without a "surgeon". I have an ASC that is giving me a hard time scheduling one without a surgeon because their high volume guy, whom they use as their gold standard, scrubs with a surgeon.

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[101N]

Billing scheme.

 

[lobelsteve]

Local for 10%, MAC for 90%. I am the surgeon.

GA is not a good choice because you might want to test the leads.....

 

[EtherBunny]

Any of you guys doing your SCS implants under GA with electrophysiologic monitoring and without a "surgeon". I have an ASC that is giving me a hard time scheduling one without a surgeon because their high volume guy, whom they use as their gold standard, scrubs with a surgeon.

Bad idea. You'll need to test the leads intraop. MAC is perfect for the vast majority of cases. Scrubbing with a surgeon is absurd. I do all of my implants and, therefore, I am the surgeon on the case. If you're fellowship trained you should be able to do the implants solo as well.

 

[Ducttape]

maybe they are doing paddle leads?

 

[NJPAIN]

Regarding GA and monitoring. many neurosurgeons using routinely for lami leads. First time I saw it was 15 years ago on visit with Ken Alo in Texas. There are quite a few papers describing technique and showing outcomes as good if not better than awake testing. I'm considering in this patient for epiducer leads because he is obese, OSA, multiple back surgeries, lead placement took long time for trial. I think that he will be all over the place under MAC, risk of obstructing in prone position if over sedated and risk of compromising sterility if he is moving around alot.
Regarding the surgeon issue, I haven't done hundreds of stims but over 20 years doing a few a year I have done enough. Majority of my career I scrubbed with surgeon. After many scheduling issues, listening to them bitching and finally thinking if a cardiologist can put in a pacer I can do this, I started to do solo. I'm not fast and still find the closure my least favorite part but I get the job done. I'm pissed at this ASC for giving me crap because the other guy who works there and does about 50 implants/year scrubs with his spine surgeon.

 

[BobBarker]

I have done many implants this year with GA and EP monitoring. It takes longer (go to sleep, place EP leads, flip, place more leads, flip back, wake up), and I don't think it adds much. We still end up following the trial even when they are detecting abdominal stim. Patients do fine with no abdominal stim. These are all perc implants with the pain physician as surgeon. I am going to do MAC for mine.

 

[emd123]

Why don't you do mac with propofol, wake the patient up for testing and work alone? I don't currently implant, but if some spine surgeon is going to be in the case why do I need to be there, and vice versa?

It's one thing if it's attending & a resident or student, but two attendings in a stim case? Seems like a waste of one person's time, especially if a perc implant, unless, as mentioned....it's to allow double billing. These cases aren't that long that you need one working on the leads and the other doing the pocket to make things go faster.

 

[lobelsteve]

Nevro: No need to test intra-op. Time saved. MAC em all, or just do under local as it is now a 15 min case.

 

[BobBarker]

15 minutes! Steve must slip the ipg in the back pocket of the patient's Levi's.

 

[lobelsteve]

15 minutes! Steve must slip the ipg in the back pocket of the patient's Levi's.

For the trial, add 15 for the implant.

And those are Miss Me jeans down here.