Just did this exact caseSorry if this has been asked before. But what’s everyone’s cutoff of stenosis for SCS? I have a cervical with diameter right at 10mm, I’m hesitating whether this Is safe to proceed w the trial or not. Thanks
Agreed. Have seen it twice. Once in fellowship and once to my partner. Epidural dex, IV dex, gabapentin, medrol dose pak. Both eventually resolved. Took a good 6-8 weeks on the one.It happens. Maybe hit her with steroids early on next time, through a catheter ideally at the highest site you were at, but something to quiet down the trauma site.
What’s the learning point from this for all of us?Just did this exact case
Trial went ok...little uncomfortable for patient during placement but not bad
Made perm incisions...placed percs leads awake as is my practice... because of the small amount of increased scar tissue from the trial and it already haven been right it was very difficult to advance the leads. Kinked two styletts. She was having a little bit of axial pressure but not too bad. But then all the sudden started having severe bilateral foot pain, neuropathic. Really intense. Allodynia. Motor intact. Did not resolve with pulling the leads back. Took everything out. Closed the incisions. No improvement after watching her in recovery for 45 minutes and with generous pain meds and gabapentin. Shipped from outpatient ASC to hospital. Stat mri scanned her. Nothing on the scans. Symptoms have largely improved at 10 days. But still some neuropathic pain. Fingers crossed things resolve completely.
I read a guideline that said <14mm relative contraindication and <10 absolute.
Wish I would have sent her for a paddle trial.