Over neuromod

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How does everyone feel about SPRINT? We had some good results when I was in training for folks that failed lumbar RFA for example

I reserve it for peripheral nerves whereby a patient doesn't want a permanent PNS implant, and for axial LBP that has failed PT, and MBB, yet is tender to palpation, which leads me to believe it's likely myofascial pain. The success with axial LBP is meh... the success with stimulating peripheral nerves is pretty good if the nerve is small. Hit or miss if it's big (sciatic).

 

[bubaghanush]

I used Sprint a few times, but not for back pain. I've done knee and shoulder. Pain recurs a few days to weeks after less pull.

Am I missing something? Doesn't seem worthwhile.

 

[mille125]

I reserve it for peripheral nerves whereby a patient doesn't want a permanent PNS implant, and for axial LBP that has failed PT, and MBB, yet is tender to palpation, which leads me to believe it's likely myofascial pain. The success with axial LBP is meh... the success with stimulating peripheral nerves is pretty good if the nerve is small. Hit or miss if it's big (sciatic).

Why not just do axon therapy?

 

[facetdoc]

In fellowship with a KOL for SPR so I see a decent amount - There is an EPG that allows you stim both at sensory and motor freq if you want to activate the multifidus. Usually you have to ask the rep to bring one, the standard only does sensory stim hz.

I'm not sure that you would see the results from 60 days of multifidus stim compared to a reactiv8 device, it can take 6-12 months to get a good idea of how they respond to multifidus stim from what i can tell so far. Sensory wise you seem to get a decent central response to pain signaling with the 60 day device - at least from the lit that has been published. I'm still skeptical of applying it to the medial branches.

Lead fracture has been a lot rarer with the newer leads. They tested the entire length of a lead in MRI and all sized fragments remain MRI conditional so no real concerns there.

 

[Snowmen96]

In fellowship with a KOL for SPR so I see a decent amount - There is an EPG that allows you stim both at sensory and motor freq if you want to activate the multifidus. Usually you have to ask the rep to bring one, the standard only does sensory stim hz.

I'm not sure that you would see the results from 60 days of multifidus stim compared to a reactiv8 device, it can take 6-12 months to get a good idea of how they respond to multifidus stim from what i can tell so far. Sensory wise you seem to get a decent central response to pain signaling with the 60 day device - at least from the lit that has been published. I'm still skeptical of applying it to the medial branches.

Lead fracture has been a lot rarer with the newer leads. They tested the entire length of a lead in MRI and all sized fragments remain MRI conditional so no real concerns there.

Leaving a piece of metal inside a patient is of no real concern?

 

[Orin]

Leaving a piece of metal inside a patient is of no real concern?

Correct. Much like abandoned pacer wires or broken pedicle screws or RF needle tips, just leave it be. The SPR wire is the smallest and most flexible wire to leave if you have to leave one, but it does not change their management, and removal is more harmful/dangerous in almost all cases.

 

[Orin]

In fellowship with a KOL for SPR so I see a decent amount - There is an EPG that allows you stim both at sensory and motor freq if you want to activate the multifidus. Usually you have to ask the rep to bring one, the standard only does sensory stim hz.

I'm not sure that you would see the results from 60 days of multifidus stim compared to a reactiv8 device, it can take 6-12 months to get a good idea of how they respond to multifidus stim from what i can tell so far. Sensory wise you seem to get a decent central response to pain signaling with the 60 day device - at least from the lit that has been published. I'm still skeptical of applying it to the medial branches.

Lead fracture has been a lot rarer with the newer leads. They tested the entire length of a lead in MRI and all sized fragments remain MRI conditional so no real concerns there.

Not a KOL.
Reactiv8 is a slow burn. SPR is faster effect.
They argue that it is the same amount of energy imparted based on the way the two companies are stimulating, but that seems like a convenient marketing sidestep.

The bimodal stimulation of their ExtensaXT can do separate motor and sensory stim to two leads, but it doesn't swap back and forth on the same lead automatically. You can use it for example to capture the axillary/deltoid for motor and the suprascapular for sensory, or multifidus for motor and nerve root for the radic.

 

[MitchLevi]

I have a SPR multifidus N of 1 (basically no good experience to even speak on this), but zero effect on multifidus SPR, very frustrating logistics as well. It requires maintenance and it fractured. Other SPR similarly failed.

 

[Snowmen96]

Correct. Much like abandoned pacer wires or broken pedicle screws or RF needle tips, just leave it be. The SPR wire is the smallest and most flexible wire to leave if you have to leave one, but it does not change their management, and removal is more harmful/dangerous in almost all cases.

I'm not saying broken wires should be surgically removed, but essentially saying it's a non issue and not even a possibility that should be considered when deciding whether to do the procedure or not is ridiculous to me.

 

[Agast]

There are definitely patients who will fixate on it and identify it as the source of all their future pain. I removed a stimulator on a high strung patient and they still think the (now gone IPG battery) is giving them sciatica. Nevermind their spine is literally now a frowny face

 

[Orin]

There are definitely patients who will fixate on it and identify it as the source of all their future pain. I removed a stimulator on a high strung patient and they still think the (now gone IPG battery) is giving them sciatica. Nevermind their spine is literally now a frowny face

Sounds like they need inversion therapy to turn that frown upside down.