Sprint PNS post lead pull results

[lmsanscafe]

Anybody seeing good results after after the leads get pulled like that company reports? I have to say they work well when they’re in, but most of the time they go back to normal after I pull them.

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[TIVAndy]

Anybody seeing good results after after the leads get pulled like that company reports? I have to say they work well when they’re in, but most of the time they go back to normal after I pull them.

Mixed bag. Data they present seems better than my results. I think for shoulder it was 50% of pts had relief at 1 yr?

 

[au bon pain]

Anybody seeing good results after after the leads get pulled like that company reports? I have to say they work well when they’re in, but most of the time they go back to normal after I pull them.

My cervical and lumbar generally do pretty well. Been doing these for 3 years, and I’ve only had to ablate maybe 2 patients where PNS for their spondy/multifidus pain wasn’t helpful for at least 6 months.

Somehow I’ve never had a shoulder or knee patient who I thought was a good candidate for this, but I would definitely consider in the right patient.

For more peripheral stuff my experience has definitely been mixed. Not having a permanent implant for these is a big limitation.
Their perm device is supposed to be released within the next year; hopefully it doesn’t suck.

 

[runfastnow]

Echo above - very good results with lumbar, cervical, and occipital nerve.

Did my first shoulder recently on a lady with chronic massive cuff tear + GH OA who is nonsurgical candidate and she is doing awesome.

Of the knees I've done (sciatic + femoral leads) none have had lasting benefit and the only complication was with a sciatic lead that got infected. Have basically stopped offering for knees but may try genicular if I find a good candidate to give it one more chance.

 

[Status Sciaticus]

My cervical and lumbar generally do pretty well. Been doing these for 3 years, and I’ve only had to ablate maybe 2 patients where PNS for their spondy/multifidus pain wasn’t helpful for at least 6 months.

Somehow I’ve never had a shoulder or knee patient who I thought was a good candidate for this, but I would definitely consider in the right patient.

For more peripheral stuff my experience has definitely been mixed. Not having a permanent implant for these is a big limitation.
Their perm device is supposed to be released within the next year; hopefully it doesn’t suck.

Youre doing PNS in lieu of MBB/RFA and getting better results after the 60 day pull?

 

[au bon pain]

Youre doing PNS in lieu of MBB/RFA and getting better results after the 60 day pull?

I always do MBB first to confirm.

And of those who respond well I offer probably 15% a choice of RFA or PNS and they pick. The majority have relief for >6 months.
As an extreme example I actually just saw a guy I did a lumbar on ~2.5yrs ago who had 2 years of relief. He wanted to know if there was a permanent device I could implant, but I’ve been hesitant to use Nalu and I don’t do Reactiv8 so I referred him to somebody who does.

 

[Status Sciaticus]

I always do MBB first to confirm.

And of those who respond well I offer probably 15% a choice of RFA or PNS and they pick. The majority have relief for >6 months.
As an extreme example I actually just saw a guy I did a lumbar on ~2.5yrs ago who had 2 years of relief. He wanted to know if there was a permanent device I could implant, but I’ve been hesitant to use Nalu and I don’t do Reactiv8 so I referred him to somebody who does.

thats what I am thinking about, is doing a MBB to Reactiv8 move for these patients rather than RFAs because of the durability, and preventing worsening multifidus atrophy, but the downside is cost and implant in the body.

 

[PMROralBoards]

Youre doing PNS in lieu of MBB/RFA and getting better results after the 60 day pull?

I offer sprint PNS as an option when I talk about rfa. I always do a mbb first as diagnostic. I’d say about 10% of my patients opt for sprint and at this point I’m beating the published average for pain relief with it

 

[RoloTomassi]

How are y'all getting this covered? What ICD10? Last I looked into it, no commercial coverage

 

[DOctorJay]

when you (@PMROralBoards and @au bon pain) are doing these cases, say for lumbar spine, are you doing bilateral leads?

 

[MitchLevi]

Cervical leads WTF?

 

[PMROralBoards]

How are y'all getting this covered? What ICD10? Last I looked into it, no commercial coverage

95% of my patients have Medicare

 

[PMROralBoards]

when you (@PMROralBoards and @au bon pain) are doing these cases, say for lumbar spine, are you doing bilateral leads?

Depends on if their pain is unilateral or bilateral. For a patient you would normally do l4-s1 rfa I would place them at the bilateral l5 vertebral level. I will stim on the table and if they are getting good coverage of where they normally have axial pain then I am happy. I like doing these for patients who have facet mediated pain at more than two levels.

 

[au bon pain]

when you (@PMROralBoards and @au bon pain) are doing these cases, say for lumbar spine, are you doing bilateral leads?

Pretty much as PMR said.
Only b/l if patient has meaningful amounts of pain on both sides. I do plenty of unilateral. Decision-making same as RFA. Never more than 1 lead per laterality.

 

[RoloTomassi]

On the unilateral cases, to you see unilateral atrophy? Any change in appearance on subsequent MRIs?

 

[1 Up]

I usually do BL 2-lvl MBBs. When you guys do MBBs, are you testing one level? Can you explain your process for what level you're placing your leads at?

 

[painisfear]

Do you need psych evaluations for peripheral stim like with spinal cord stim?

 

[bubaghanush]

Is anyone aware of good data on Sprint PNS after lead-pull? I went 1.5 years ago to a course, and they just had a bunch of abstracts with sub-par data trying to sell pain relief after lead pull. I don't do a lot of Sprint but my experience mirrors this exactly - pain relief wears off quickly after pull.

Maybe new studies have been published in the meantime.

 

[au bon pain]

I usually do BL 2-lvl MBBs. When you guys do MBBs, are you testing one level? Can you explain your process for what level you're placing your leads at?

Do MBBs to cover patient’s area of pain. I then have the patient identify what they think is center of their painful region and place the lead at the closest medial branch corresponding to that area.

 

[clubdeac]

I can no longer get these covered in my area even in my Medicare patients. They require a psych screen and we must state that the price of a 60 day trial is to determine appropriateness and eligibility of a permanent system. It’s like they copy and pasted the requirements for SCS. I haven’t gotten one approved in months. It’s ludicrous

 

[PMROralBoards]

I can no longer get these covered in my area even in my Medicare patients. They require a psych screen and we must state that the price of a 60 day trial is to determine appropriateness and eligibility of a permanent system. It’s like they copy and pasted the requirements for SCS. I haven’t gotten one approved in months. It’s ludicrous

We use an online service where they call the patient to go over a checklist of questions and then we get the approval. The service is covered by Medicare. You could always consider sprint as a 60 day trial to include late responders that wouldn’t be captured by a nalu trial. If the pain comes back after lead pull, transition to nalu.

 

[PMROralBoards]

I usually do BL 2-lvl MBBs. When you guys do MBBs, are you testing one level? Can you explain your process for what level you're placing your leads at?

I do the normal two level mbb. When I place the lead I just make an educated guess. I ask if it is covering their pain distribution. I try to have the stim level be lower than 50 for them to feel the distribution. If it’s higher then I will either adjust or change the level. If the pain is unilateral I will still do two leads but different levels rather than same level bilateral. I’ve also had good success with this on patients with an acdf for what it’s worth.