SCS trial - 1 or 2 leads?

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APDoc

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For those of you who perform your share of SCS trials, do you typically place 2 leads or 1 lead for your trials? I am speaking mainly about coverage for a FBSS patient with persistent back and bilateral lower extremity neuropathic pain.

In our fellowship, we always did 1-lead trials and frankly I thought they went pretty well. A lot of the guys around me in practice use 2 leads every time, but unless I can't achieve coverage with 1 lead I can't see a good reason to place 2.

Am I missing something (outside of the extra $ by not always placing 2)?

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For those of you who perform your share of SCS trials, do you typically place 2 leads or 1 lead for your trials? I am speaking mainly about coverage for a FBSS patient with persistent back and bilateral lower extremity neuropathic pain.

In our fellowship, we always did 1-lead trials and frankly I thought they went pretty well. A lot of the guys around me in practice use 2 leads every time, but unless I can't achieve coverage with 1 lead I can't see a good reason to place 2.

Am I missing something (outside of the extra $ by not always placing 2)?



I almost always do one unless there is a coverage issue during programming. I think that I am in the minority on this.
 
for bilat symptoms, i do one lead, but rely on the testing to determine if a second lead is necessary. generally, for unilateral symptoms, i dont put in a 2nd lead.
 
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low back, at least two leads.
unilateral arm or leg, start with one
bilateral limbs, sometimes one lead sometimes two
pudendal neuralgia, 4 leads (2 at conus 2 through S2)
etc...
 
low back, at least two leads.
unilateral arm or leg, start with one
bilateral limbs, sometimes one lead sometimes two
pudendal neuralgia, 4 leads (2 at conus 2 through S2)
etc...
When you do 4 leads, do you do them at two sittings? or use 4 quads?
 
same thing in fellowship used just one lead.

now i use 2 leads. My rationale is that i'm trying to give my patient the best possible chance at this trial. As you know with trials we are securing with typically non-suture materials. As a result, although minimal, there's a possibility tht a lead can migrate. So in the event one does, the rep can usually reprogram adn capture with the other lead therefore salvaging the trial.
 
Started with one lead, but I now generally use two for the same reasons pinch mentioned.
I've found that patient's often have better trials with two leads and this does a better job of simulating what a paddle lead will do for them, particular if they have a lot of lumbar pain, bilateral leg, or very contrasting leg symptoms.

I generally use one lead for patients with straight unilateral leg symptoms, w/o significant lumbar. Also just use one lead for patients with tough insertions/anatomy.
 
When you do 4 leads, do you do them at two sittings? or use 4 quads?

I'll use 4 quads in one sitting usually. Have gotten approval from some insurances for 4 octrodes (though I think quads in the sacrum may be sufficient). Put two at conus, and then two over s2/s3/s4 via retrograde or if not possible, place a quad via a s2/s3 transforaminal approach, which is fairly easy. I think I posted images of this earlier...

Paddle for conus. So much space in there I need to paddle to take up space. Once it scars down, positional changes usually cease and patient happy with coverage.

My n is low at this time but seeing more of these patients lately.
 
I'll use 4 quads in one sitting usually. Have gotten approval from some insurances for 4 octrodes (though I think quads in the sacrum may be sufficient). Put two at conus, and then two over s2/s3/s4 via retrograde or if not possible, place a quad via a s2/s3 transforaminal approach, which is fairly easy. I think I posted images of this earlier...

Paddle for conus. So much space in there I need to paddle to take up space. Once it scars down, positional changes usually cease and patient happy with coverage.

My n is low at this time but seeing more of these patients lately.


so you have surgeon place paddle at conus. then what about the ones in the sacral foramina/retrograde region when it comes for permanent. Are you in the OR with the surgeon? Are you having surgeon do his part one day, and then bringing patient back and implanting sacral/retrograde on another day?
 
so you have surgeon place paddle at conus. then what about the ones in the sacral foramina/retrograde region when it comes for permanent. Are you in the OR with the surgeon? Are you having surgeon do his part one day, and then bringing patient back and implanting sacral/retrograde on another day?

I have the surgeon place conus and sacral leads. Implanting is getting less compatible with my busy schedule. Surprisingly, however, the past couple have only needed the conus paddle placed, as they get sufficient coverage from that!
 
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