Sprint PNS Lumbar Radic

[runfastnow]

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Scenario / Question for the Group:

Have a patient with active L5 radic likely from stretch injury during a L5-1 fusion performed ~2 months ago. EMG confirmed L5 radic this week. Post-op MRI negative for compressive lesion of L5. Patient has terrible neural tension signs, classic L5 dermatome pain, etc.

Planning on doing an ESI this week but we discussed doing Sprint PNS for the L5 nerve root after seeing some stuff from NANS and new procedure info from SPR. Patient really wants to avoid further implants/permanent devices.

1 - Has anyone had success with Sprint for radicular pain?
2 - If successful, but not durable, as anyone had success transitioning to SCS or DRG if using Sprint as "trial"?

 

[lobelsteve]

Do ESI.
Load up on neuropathics/B complex/ALA.
If not better or improving in next month or two then SCS.

 

[SSdoc33]

how about giving this some time? ESI if fine, and id do that as well, but need to wait probably a year before considering SCS

 

[clubdeac]

Scenario / Question for the Group:

Have a patient with active L5 radic likely from stretch injury during a L5-1 fusion performed ~2 months ago. EMG confirmed L5 radic this week. Post-op MRI negative for compressive lesion of L5. Patient has terrible neural tension signs, classic L5 dermatome pain, etc.

Planning on doing an ESI this week but we discussed doing Sprint PNS for the L5 nerve root after seeing some stuff from NANS and new procedure info from SPR. Patient really wants to avoid further implants/permanent devices.

1 - Has anyone had success with Sprint for radicular pain?
2 - If successful, but not durable, as anyone had success transitioning to SCS or DRG if using Sprint as "trial"?

I read the new data regarding SPRINT for radicular pain and was going to try it. Will let you know if I do

 

[runfastnow]

how about giving this some time? ESI if fine, and id do that as well, but need to wait probably a year before considering SCS

For sure - guy has very reasonable expectations and wants to slow play it if possible/tolerate the symptoms.
Just seems like a good case for a temporary neuromod > permanent implant if ESI/meds fail. Even though unproven right now.

 

[Snowmen96]

Scenario / Question for the Group:

Have a patient with active L5 radic likely from stretch injury during a L5-1 fusion performed ~2 months ago. EMG confirmed L5 radic this week. Post-op MRI negative for compressive lesion of L5. Patient has terrible neural tension signs, classic L5 dermatome pain, etc.

Planning on doing an ESI this week but we discussed doing Sprint PNS for the L5 nerve root after seeing some stuff from NANS and new procedure info from SPR. Patient really wants to avoid further implants/permanent devices.

1 - Has anyone had success with Sprint for radicular pain?
2 - If successful, but not durable, as anyone had success transitioning to SCS or DRG if using Sprint as "trial"?

Regarding point #2, I would probably do SCS instead of DRG in this case. The insertion of the lead in the foramen can be very stimulating for patients and takes significant real estate, so I'm not sure I'd want to stick a lead in there, especially if there is already nerve damage in this location. The other thing is that it wouldn't be possible from a technical point of view if they had a surgery at that level that involved a laminectomy/decompression on top of the fusion.

 

[Orin]

Scenario / Question for the Group:

Have a patient with active L5 radic likely from stretch injury during a L5-1 fusion performed ~2 months ago. EMG confirmed L5 radic this week. Post-op MRI negative for compressive lesion of L5. Patient has terrible neural tension signs, classic L5 dermatome pain, etc.

Planning on doing an ESI this week but we discussed doing Sprint PNS for the L5 nerve root after seeing some stuff from NANS and new procedure info from SPR. Patient really wants to avoid further implants/permanent devices.

1 - Has anyone had success with Sprint for radicular pain?
2 - If successful, but not durable, as anyone had success transitioning to SCS or DRG if using Sprint as "trial"?

It's rather acute, but if you don't want to do steroid, I have done SPR for this indication. I think the MSKCC folks published on it already if you need a reference.

Mostly I have done this for patients that need surgery but can't do it within the next 6 - 18 months for whatever reason, but my last one was for a similar scenario but 6 - 12 3 months out. My NSGY folks have one them on their schedule for a possible DRG conversion, but still early on as the SPR was removed recently.

My gestalt is that if SPR works, most PNS will work if you can capture the nerve, and then DRG ~ PNS but not the same as SCS.
In this case, SCS would or PNS would work

Insurance coverage can be a problem and I would consider it more of a SNRB approach than an outside-in DRG approach

 

[au bon pain]

It's rather acute, but if you don't want to do steroid, I have done SPR for this indication. I think the MSKCC folks published on it already if you need a reference.

Mostly I have done this for patients that need surgery but can't do it within the next 6 - 18 months for whatever reason, but my last one was for a similar scenario but 6 - 12 3 months out. My NSGY folks have one them on their schedule for a possible DRG conversion, but still early on as the SPR was removed recently.

My gestalt is that if SPR works, most PNS will work if you can capture the nerve, and then DRG ~ PNS but not the same as SCS.
In this case, SCS would or PNS would work

Insurance coverage can be a problem and I would consider it more of a SNRB approach than an outside-in DRG approach

How did your patient do with this in terms of % relief and duration?

 

[clubdeac]

It's rather acute, but if you don't want to do steroid, I have done SPR for this indication. I think the MSKCC folks published on it already if you need a reference.

Mostly I have done this for patients that need surgery but can't do it within the next 6 - 18 months for whatever reason, but my last one was for a similar scenario but 6 - 12 3 months out. My NSGY folks have one them on their schedule for a possible DRG conversion, but still early on as the SPR was removed recently.

My gestalt is that if SPR works, most PNS will work if you can capture the nerve, and then DRG ~ PNS but not the same as SCS.
In this case, SCS would or PNS would work

Insurance coverage can be a problem and I would consider it more of a SNRB approach than an outside-in DRG approach

can you comment on your technique for placing it in the foramen. Is the SPRINT DRG placement any different than a traditional TFESI except you stop at the posterior foramen instead of advancing to the middle or anterior foramen?

 

[mdo1738]

I haven’t done any for this but this is their recommended placement.

 

[pmrmd]

PRP epidural before any neuromodulation