Activity restriction after SCS implant

[lmsanscafe]

Is there a good resource or guideline regarding this? What is your recommendation for your patients if they feel well enough to lift weights, run, swim, etc? Does it matter how long they’re removed from the implantation? Last follow up is does it differ if it’s a pump?

Inputs appreciated and thx in advance.

---

Members don't see this ad.

 

[paindoc007]

No blt for 6 wks.
Abd binder when oob
Biggest risk of not is lead migration which sucks.

 

[lmsanscafe]

Thanks. Any restrictions after 6 weeks?

 

[MitchLevi]

Thanks. Any restrictions after 6 weeks?

Perc implants come at a certain cost with regard to post-implant activities, paddles much less so.

The types of activities that should be avoided are obvious.

I have pts who refuse to behave and do whatever they want and somehow the leads are still there several yrs later, and I have leads that have fractured and migrated outside the epidural space in pts who are very sedentary.

A pt who is going to require a lot of activity (manual labor for example) gets a paddle in my practice, especially young pts.

I promise you, the first time you revise a migration you'll question why you even offer this procedure to anyone. Seems like any revision I've ever done (whether I'm the original implanter or not), the reps always say both leads must be replaced. Interesting...

 

[TIVAndy]

No blt for 6 wks.
Abd binder when oob
Biggest risk of not is lead migration which sucks.

No bacon lettuce tomato? Thats harsh

 

[lobelsteve]

No bacon lettuce tomato? Thats harsh

or ranch.

For those at home who do not have reps with cute phraseology:

BLT with ranch = bending, lifting, twisting, reaching.

 

[painfree23]

Wat about playing golf a year after paddles?

 

[paindoc007]

Wat about playing golf a year after paddles?

Just fine. I heard Abbott was trying to sell their **** to Tiger back in the day prior to his fusion..

 

[MitchLevi]

Wat about playing golf a year after paddles?

No issues with a paddle, just remind them (if we're talking FBSS) they've got a back issue culminating in a freaking stimulator and probably need a new hobby.

If you put percs in a golfer you'll probably end up revising them at some point.

 

[lobelsteve]

I do perc leads in golfers all the time. Ot an issue after 6 weeks.

 

[MitchLevi]

I do perc leads in golfers all the time. Ot an issue after 6 weeks.

You must be magical.

 

[Asclepius186]

How many people do abdominal binders? What’s the benefit? Prevent seroma? More protection for wound?

 

[painfree23]

Just fine. I heard Abbott was trying to sell their **** to Tiger back in the day prior to his fusion..

Did he do it?

 

[lobelsteve]

You must be magical.

More hobbit than wizard.
6 weeks in TLSO.

 

[Ducttape]

You must be magical.

i have too (in golfers). no issues with paddle leads.

More hobbit than wizard.
6 weeks in TLSO.

well, in your minds eye, sure you arent Tom Bombadil???

 

[paindoc007]

Did he do it?

Lol. No

 

[Centurion38]

with the modern anchoring systems, and careful attention to suturing, the leads rarely move after 6 weeks in the absence of significant trauma or repetitive vigorous overhead motions like lat pulldowns.

I also use fixate devices which, while expensive, are well worth it IMO. Golf is rotary (if you're doing it right) and SCS implants will be fine.

 

[lobelsteve]

i have too (in golfers). no issues with paddle leads.

well, in your minds eye, sure you arent Tom Bombadil???

I am not. Fa la la la lolly.

 

[MitchLevi]

I've implanted golfers too. Prefer not to...

 

[Darkside_]

What do you guys use to secure your SCS trial leads? My last trial patient scratched under his occlusive dressing "because it was itchy" and one lead was hanging out by the time he came in for the pull

 

[RoloTomassi]

What do you guys use to secure your SCS trial leads? My last trial patient scratched under his occlusive dressing "because it was itchy" and one lead was hanging out by the time he came in for the pull

Stayfix. A little costly but quick and very secure.

 

[lobelsteve]

What do you guys use to secure your SCS trial leads? My last trial patient scratched under his occlusive dressing "because it was itchy" and one lead was hanging out by the time he came in for the pull

2-0 Vicryl x2 on each lead. A dab of dermabond over stab incision site to prevent bleeding. Benzoin and steri-strips as leads exit Vicryl.
Dressings over this done by my nurses and SCS reps.

 

[unchockey21]

What do you guys use to secure your SCS trial leads? My last trial patient scratched under his occlusive dressing "because it was itchy" and one lead was hanging out by the time he came in for the pull

I also suture the leads. I’ll throw some knots then create a strain relief loop and throw more using the same suture. Then mastisol, steris, and dressing.

 

[soccrwz]

I think there was an SCS fact finder on this recently noting increased migration with stitching. I use mastisol steristrips, tegaderm. I've had minimal migration.

 

[RoloTomassi]

If the leads move, it's almost always under the surface, from patient motion, and there's nothing other than education you can do about that, other than place leads 1/2 - 1 level higher than target in anticipation.

 

[unchockey21]

I think there was an SCS fact finder on this recently noting increased migration with stitching. I use mastisol steristrips, tegaderm. I've had minimal migration.

I think this is the fact finder you mentioned. They sutured to silastic anchors, not to the leads themselves.

https://cdn.ymaws.com/www.spineintervention.org/resource/resmgr/factfinder/21/06.ff.scs.lead.migration.pdf

 

[MitchLevi]

I suture to the leads themselves.

Trials migrate.

 

[lobelsteve]

Truth be told.
Trials do migrate.
We have a bend test procedure immediately post-trial after leads sutured. Set the leads.
Patient gets up, bends to 90 degrees at waist with partial squat. Then back on table. This allows for more accurate programming.

 

[pmrmd]

Infinion 16-contact lead, find the spot, then advance the lead a half-level or full level cephalad. Secure with strips/tagaderm or Ioban and done.

 

[paindoc007]

Infinion 16-contact lead, find the spot, then advance the lead a half-level or full level cephalad. Secure with strips/tagaderm or Ioban and done.

This.

 

[MitchLevi]

I trial with electrode 1 mid T7.

 

[painfree23]

I trial with electrode 1 mid T7.

Nevro like waaaaaaat?

 

[MitchLevi]

Nevro like waaaaaaat?

I haven't used a Nevro device in probably a yr. If it's Nevro electrodes 1 on both leads are mid T7 and 8.