New SCS technology

[epidural man]

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So....

I'm a constant current guy myself - so don't use medtronic.

But perhaps the MRI compatability might be a game changer for me. Our institution has 3T machines however (I think we still have a 1.5T in the basement) - and the system is only FDA approved for 1.5T.

Has anyone tried it yet? We had an engineer come talk to us about the system. It really is designed well and it is an impressive piece of machinary.

On another topic, I just tried those new anchor/suture system that Boston Scientific has. Those things are another engineering wonder. They were so slick. It took me 30 sec to secure the anchors with incredible precision and it appeared very sturdy. I'm not sure the $1200 per anchor justifies the time saved. If time were an issue for me, it might - and probably for some of you, it may be. The rep told me that they are letting each physician try 2 for free. You all need to get a hold of at least those free ones and try it.

I guess it used to be called something else by another company before BS bought them.

http://forums.studentdoctor.net/archive/index.php/t-981979.html

 

[emd123]

It's a potential game changer.

Not to derail the thread, but is constant current really any better, or just BSci hype? Medtronic stim seems to work just fine.

 

[Aether2000]

The MDT MRI compatible system is absolutely a game changer and I have put on hold all other company's scheduled implants, switching them to MDT. It is unconscionable for me to implant a non-MRI compatible system given that we are relegating patients to second string diagnostics for the next decade by implanting non Medtronic systems. While I strongly prefer the RF programming of Boston and their new programming electronic automatic systems and their fractional charges, I cannot justify excluding patients from current standard of care diagnostic technology based on those features alone.

 

[Ducttape]

The MDT MRI compatible system is absolutely a game changer and I have put on hold all other company's scheduled implants, switching them to MDT. It is unconscionable for me to implant a non-MRI compatible system given that we are relegating patients to second string diagnostics for the next decade by implanting non Medtronic systems. While I strongly prefer the RF programming of Boston and their new programming electronic automatic systems and their fractional charges, I cannot justify excluding patients from current standard of care diagnostic technology based on those features alone.

medtronics apparently is "working" on the technology for MRI compatible paddle leads. i prefer paddle leads for a variety of reasons. fortunately, the summer has been relatively quiet of implants, so...

 

[deleted185747]

A non-medtronic rep told me that MRI techs are the ones liable if a lead causes harm during the scan and that the techs don't care if it MRI compatible, they still don't want to do the scan.

 

[geauxg8rs]

I have faced the MRI techs reluctance in patients who have MRI safe pacers. It took a motivated and educated patient to finally cut through the red tape and not just end up with a ct scan. Took a lot of work on their part. The techs are hourly workers who just don't care or want to work.

 

[nvrsumr]

The medtronic reps in my area have contacted all the local imaging centers. They have about 20 who have agreed to the protocol.

Agree with everyone else. MRI compatibility is pretty great. Im going back to doing my own implants til the paddle leads come out.

 

[PinchandBurn]

Had discussions with a few people abou this in the beginning of the year, including with neurosurgeons in the area.

Medtronic obviously claims this is a 'game changer', but the jury is still out on that...

The exception is if someone has a KNOWN brain tumor. But even then, most neurosurgeons in the area state getting a PET SCAN, 3dCT or even CT angiogram is just as good.

Secondly, I haven't run into a whole lot of folks that have had to have their stims removed because they needed a MRI. At this meeting, most guys in the room that had 15+ years in the room all stated the same. One guy said in his entire career he had to remove just one (he implants a lot of stim).

Plus as others mentioned, it's not approved for paddles anyways....

Thirdly the responsibility regardless of whether it's MRI 'conditional' or not, is still yours....MDT will not stand by you.

The discussion basically came down to why are we putting SCS in patients anyways? The reason is NOT for MRI compatibility. It's for pain management for chronic pain. So do what's best for the patient's pain. As many here have mentioned, boston sci's technology with it's fractionalization,etc still appears to be the most technologically advanced....

 

[Ducttape]

i disagree on several points.

we are putting these devices in patients with chronic pain.

there are many patients that require yearly surveillance with MRI imaging for prior malignancy, in remission. i have at least 5 patients in this situation.

yearly CT scan imaging, while can be done, is probably not optimal given their prior malignancy.

the reason folks are not taking out stims on these people - they never get them, are never considered, because of the need for yearly MRI.


and few stims are being taken out because the time frame - does a patient with suspected cancer wait 2-3 months to get scheduled for a lead to be removed then get an MRI, or does an oncologist agree to a study that has more radiation, more contrast, may or may not provide as much information, just so he can initiate therapy 2-3 months earlier?


finally, do you have any studies that boston sci's technology provides better pain relief?


oh and fyi, forgive me if i am being presumptuous - but the MRI compatability is entire body MRI, not just brain... only because you mention brain tumor...

 

[emd123]

finally, do you have any studies that boston sci's technology provides better pain relief?

I've asked this question myself. I've asked the Boston Scientific reps to show me a study, not device-company sponsored, that tests the three companies products head to head. They can't produce it. If it existed, they'd have it plastered all over planet earth and stapled to their foreheads.

 

[nvrsumr]

i've asked this question myself. I've asked the boston scientific reps to show me a study, not device-company sponsored, that tests the three companies products head to head. They can't produce it. If it existed, they'd have it plastered all over planet earth and stapled to their foreheads.

1+

 

[Ligament]

For you implanters; how do you justify it financially? I'd like to do more implants but it takes a massive chunk of time out of my day for minimal reimbursement.

 

[Aether2000]

Batch OR cases into one day. Save time by just stapling the perm generator to the external skin....jk

 

[PinchandBurn]

I agree no studies that demonstrate one is better than the other.

I'm sure everyone feels the company they use is better. I can tell you that anecdotally Boston Sci is easier to program, especially with the new SPectra because they can run so many programs and fractionalize so quickly that the 'sweet spot' can be found efficiently.

Also especially for many of the patinets that typically have 'arthritis' and cant really recharge that easy, I think the wireless platform and charging are helpful for these patients that cant 'reach back' ,etc.

Do I implant. Yes. I try to do them all on one day. That way the OR staff, are all prepared and efficient. Implant time ranges between 30-45min. Typically we try to do like 4 of 5 on the same day (once a month). What makes it tough is the OR turn over times (usually 30-45min). Could I be doing like 20 injections and probably making more. Probably. But I do believe SCS therapy works in carefully selected patients, so I'm ok with taking a 'hit'. So far in the last 2.5 years, everyone has been doing well. Most have either been 100% off of opioids or are taking 50-75% less (yes I do track this). No one so far has gained tolerance to the therapy.

 

[mille125]

I've asked this question myself. I've asked the Boston Scientific reps to show me a study, not device-company sponsored, that tests the three companies products head to head. They can't produce it. If it existed, they'd have it plastered all over planet earth and stapled to their foreheads.

Everyone has their own personal preference but over time they are all the same.

 

[Jcm800]

For you implanters; how do you justify it financially? I'd like to do more implants but it takes a massive chunk of time out of my day for minimal reimbursement.

Sometimes you have to suck it up and do what's right, even if it doesn't pay. A Mac, perc implant by me most of the time is better for the patient then general and a laminectomy...
I would love to refer them out, but can't justify it...

 

[ultm8frisbee]

.

 

[epidural man]

It's a potential game changer.

Not to derail the thread, but is constant current really any better, or just BSci hype? Medtronic stim seems to work just fine.

No studies to prove either way...so we are only left with what we know of basic science (V=IR), and anectodal evidence.

I have seen patients verbally tell me that constant current "feels" better after hookup with the OMG.

I think longetivy for me is a concern as resistance builds up around the lead - being able to produce the same electrical field (constant current) makes sense to me.

Also, it is hard to argue that 16 or 32 independent source generators aren't superior.

In the end, it doesn't matter if they are different. If I - the consumer - BELIEVE they are different, a savy company would realize that the customer wants constant current and they would provide it.

Are any of you musicians? Do you know the Nyquist therom? It states that you only need a sampling rate twice that of your music frequency. The most excellent human ear can only hear up to 20KHz, so 40Khz sampling is all that is needed (hence why CD's are 44KHz). However, if you buy a analog to digital converter for you computer today, they ALL sample at 96KHz - which is a complete waste of computer space and processing power. All the music engineers know this - so why do they sell it with the ability to sample at 96KHz? IT IS BECAUSE THE STUPID CONSUMERS DON'T KNOW ANY BETTER AND THEY DEMAND 96KHz sampling. So the smart companies provide and sell lots of product.

My point is, if it doesn't matter - who freakin' cares. How difficult is it for those *****s over at medtronic to make a battery that is constant current?

 

[pmrrmp]

Your music analogy makes me laugh. Reminds me of the bottled water debate, best illustrated by Penn and Teller: http://www.youtube.com/watch?v=MHx6BX3HZJc

Just skip to the taste testing in the video.

 

[Ducttape]

relying on anecdotal evidence is what got us into some of the problems we face in chronic pain management today.

show me a single study that constant current leads to better improvement in the long term.

if there is no evidence based medicine to clearly elucidate your point, then there is no true scientific basis for it. and we DONT just give the consumer what they want. otherwise, we would have a prescription opioid epidemic.


oh wait....

 

[Aether2000]

lol...just as we have an epidemic of spinal steroid injections and inappropriate spinal cord stimulator implants. Ya just can't get away from inappropriate use in virtually every aspect of pain medicine, and for that matter, much of medicine in general.

 

[epidural man]

relying on anecdotal evidence is what got us into some of the problems we face in chronic pain management today.

show me a single study that constant current leads to better improvement in the long term.

if there is no evidence based medicine to clearly elucidate your point, then there is no true scientific basis for it. and we DONT just give the consumer what they want. otherwise, we would have a prescription opioid epidemic.


oh wait....

Without any EBM to compare which company to use leaves the physician having to use other means to decide which company to use.

My analogy to the music industry has NOTHING to do with letting the patient decide - in this case, I was referring to the physician as the consumer. The physician - once they have decided that SCS is the appropriate technolgoy - HAS to decide on a product. In the abscence of a study comparing them, they have to use something to base the decision on. Not sure what is wrong with anecdotal evidence in this case. Do you?

Your comparison to using anectdotal evidence given us a problem in pain medicine - to using anectdotal evidence in this case, is a horrible comparison.

 

[Ducttape]

Without any EBM to compare which company to use leaves the physician having to use other means to decide which company to use.

My analogy to the music industry has NOTHING to do with letting the patient decide - in this case, I was referring to the physician as the consumer. The physician - once they have decided that SCS is the appropriate technolgoy - HAS to decide on a product. In the abscence of a study comparing them, they have to use something to base the decision on. Not sure what is wrong with anecdotal evidence in this case. Do you?

Your comparison to using anectdotal evidence given us a problem in pain medicine - to using anectdotal evidence in this case, is a horrible comparison.

VS.

I have seen patients verbally tell me that constant current "feels" better after hookup with the OMG.

I think longetivy for me is a concern as resistance builds up around the lead - being able to produce the same electrical field (constant current) makes sense to me.

Also, it is hard to argue that 16 or 32 independent source generators aren't superior.

In the end, it doesn't matter if they are different. If I - the consumer - BELIEVE they are different, a savy company would realize that the customer wants constant current and they would provide it.

so you admit that the second comment is not using anecdotal evidence to decide what stim company to use?

the lack of EBM does not presuppose that one technology is better than the other. Rather, the null hypothesis that remains is that all technologies are the same.

ergo, up until recently, i had used 2 stim companies equally.

 

[epidural man]

, up until recently, i had used 2 stim companies equally.

well one can't argue with that.

 

[spinal]

This is a game changer for me.