Occipital Nerve PNS

[SC Tian]

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My partner did a peripheral nerve stimulation procedure in the back, which subsequently migrated to the anterior thigh. In my opinion, the forward and lateral migration of those peripheral leads is quite common. I’m curious to know if there’s a viable method to prevent it from entering the C2 spinal canal.

 

[clubdeac]

I did one of these recently after the patient had tried, ESIs, C2-4 CRFA, GONB, PT, neck brace, meds, etc. Similar placement to the article with a shallower entry and dipped down to final target. Pt isn't a surgical candidate, older gentlemen, with kyphosis. He did excellent, during the trial, just implated, post op upcoming. I'll keep you posted.

Aren’t you worried about hitting the vert as it traverses the posterior C1-2 joint?

 

[JFS]

Aren’t you worried about hitting the vert as it traverses the posterior C1-2 joint?

Vert is directly lateral to the lateral C1-2 joint. You may be thinking C0-1.

 

[Orin]

This is a hardware problem for sure, but there are differences in their risk for this and mitigation steps.

The SPR system doesn't have a strong enough barb to rachet itself in
The Curonix/Stimwave system barb is very stiff and does rachet depending on how it is placed/anchored. It has significant stiffness to its lead which causes a bit of a pistoning effect unless you anchor that posterior tail/curve down well.

The Nalu system has a barb that is weaker than the Curonix in strength, but the lead is more stretchy and the micro-IPG creates a solid anchoring point to reduce migration inward/outward

The Bioventus Stimrouter system is very stable although the new Tailismann system may cause it to retract/stretch more with the microIPG holding the tail

 

[SC Tian]

What are your thoughts on using the Abbott cord stimulation system? The IPG is very small, so we could even implant it in the shoulder.

This is a hardware problem for sure, but there are differences in their risk for this and mitigation steps.

The SPR system doesn't have a strong enough barb to rachet itself in
The Curonix/Stimwave system barb is very stiff and does rachet depending on how it is placed/anchored. It has significant stiffness to its lead which causes a bit of a pistoning effect unless you anchor that posterior tail/curve down well.

The Nalu system has a barb that is weaker than the Curonix in strength, but the lead is more stretchy and the micro-IPG creates a solid anchoring point to reduce migration inward/outward

The Bioventus Stimrouter system is very stable although the new Tailismann system may cause it to retract/stretch more with the microIPG holding the tail

 

[Orin]

What are your thoughts on using the Abbott cord stimulation system? The IPG is very small, so we could even implant it in the shoulder.

Yeah, that's what a lot of neurosurgeons will do with off label SCS hardware and open placement. I'm fine with it but it would be nicer to have MRI conditionality maintained. I'm hopeful in the next few years we'll have dedicated on-label IPGs for PNS with Boston buying Nalu, but it's a challenging market. The energy requirements in the peripheral space can be a higher even though they don't normally use HF10 style programming.