Dorsal Column Stimulation Vs. Selective Nerve Root Stimulation: which?

[Ligament]

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Lets say you have a patient with a chronic left L5 radiculitis and a SCS trial is planned.

At what point do you decide to do thoracic dorsal column stim vs. selective nerve root stim in a case like this?

Personally, if it is discreet like this and I think I can pass a lead retrograde to L5, that is what I'll do, as I am guaranteed L5 coverage into the foot in particular. If I don't think I can get a lead in there, then thoracic dorsal column stim with dual octrodes usually.

Are there any studies looking at this that you are aware of?

 

[101N]

Lets say you have a patient with a chronic left L5 radiculitis and a SCS trial is planned.

At what point do you decide to do thoracic dorsal column stim vs. selective nerve root stim in a case like this?

Personally, if it is discreet like this and I think I can pass a lead retrograde to L5, that is what I'll do, as I am guaranteed L5 coverage into the foot in particular. If I don't think I can get a lead in there, then thoracic dorsal column stim with dual octrodes usually.

Are there any studies looking at this that you are aware of?

It - selective cervical root stim - was discussed in Neuromodulation recently. Barolat commented that there is too much lead migration. I'd trial with percs and send for a paddle.

 

[lobelsteve]

I remember a brilliant lecturer at St Jude course a few years ago who detailed the importance of redundancy in coverage. While a dual octrode array at T8-9 would do well in 90% of all left leg pain patients, an octrode and quad at T8-9 and a quad at T12-L1 left paramedian would be potentially better. Retrograding a lead from L2-3 to the L4 pedicle starting right paramedian would also cross the L4-S3 roots and is very useful for stubborn foot coverage.
Man, that guy was the sht.

 

[Ducttape]

can you or your implanter get paid for this, tho?

the ins companies i am working on are really fighting against any stim not spinal cord....

 

[lobelsteve]

can you or your implanter get paid for this, tho?

the ins companies i am working on are really fighting against any stim not spinal cord....

As long as leads are in the epidural space it all counts. When they go outside the epidural space and not over named nerves is when it becomes problematic.