Threading caths or stims thru surgical sites?

[Timeoutofmind]

Do you guys ever do this?

If u do, what is your method...look at MRI first to see if room, and then stop if significant resistance?

I see a lot of post cervical fusion people who could benefit from scs. In fellowship, we basically did not, just placed stim at inferior margin of surgical site, but that kinda sucks.

My main concern is bleeding, and also ripping thru the dura...

And how about epidural adhesiolysis? Anyone just take a catheter to the level of interest and squirt saline and move the catheter around and repeat? Do you feel it is safe and effective? Can u still bill for this?

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[Taus]

Surprising if you're seeing a lot of posterior cervical fusions. If you're talking about acdf then no problem threading through a stim lead as long as there is not too much central stenosis. Otherwise, I would not thread a lead or catheter through a posterior surgical level. Either enter above if possible or send for surgical paddle trial

As for catheter and injecting whatever underneath or close to site.... probably safe and worth trying to squirt some steroid before considering stim. As for lysis adhesions... Generally a waste of time

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[Timeoutofmind]

Thanks much. Confirms what I thought.

I guess someone better be a pretty darn good scs candidate if I am gonna refer for surgical paddle lead trial...esp given the increased risk for the surgeon and pt as he would have to go at a prior surgical level. That assumes they have enough epidural space there too for that bigger paddle lead. I don't even know if my spine surgeons would be willing...

Surprising if you're seeing a lot of posterior cervical fusions. If you're talking about acdf then no problem threading through a stim lead as long as there is not too much central stenosis. Otherwise, I would not thread a lead or catheter through a posterior surgical level. Either enter above if possible or send for surgical paddle trial

As for catheter and injecting whatever underneath or close to site.... probably safe and worth trying to squirt some steroid before considering stim. As for lysis adhesions... Generally a waste of time

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[ateria radicularis magna]

This is something I have been thinking a lot about as well. So does this mean no perc stim trial for any patient with history of low thoracic spine surgery? Maybe I should just ask the question from an even broader perspective--when will you NOT stim someone?

Thanks in advance!

 

[Ducttape]

i would definitely think twice about suggesting a surgical paddle lead trial.

most surgeons I talked to would only do this in the sitting position, and from an anesthesiology standpoint, this carries a higher risk of complications.

 

[lobelsteve]

The epidural space is a potential space. Once posterior surgery occurs, that potential space is gone.
Analogy: A tunnel on a highway. Then cave it in. A lead should pass through there any longer.

 

[Taus]

i would definitely think twice about suggesting a surgical paddle lead trial.

most surgeons I talked to would only do this in the sitting position, and from an anesthesiology standpoint, this carries a higher risk of complications.

I've had a different experience, but may also be bc I typically send all implants to the functional neurosurgeons at Jefferson who have far more stim expertise than the typical spine surgeon. I've sent two in 3 years for surgical trials. Both fused t10-sacrum. Both did great.

One pending for c spine. Fused anterior and later posterior at c67. Pure neuropathic arm pain failed all I have to offer.


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[giddyup]

Had a fun time with this one the other day. Eventually I got the left lead a little more midline but it was not easy because it was bowing as I tried to thread it. T/L MRIs beforehand and talked with surgeon who did the rods.

 

[lobelsteve]

Had a fun time with this one the other day. Eventually I got the left lead a little more midline but it was not easy because it was bowing as I tried to thread it. T/L MRIs beforehand and talked with surgeon who did the rods.

Post the pain diagram. And MRI results from L-spine. Those rods and wires are all extraspinal. Same as doing it with CABG wires in way on Xray.

 

[giddyup]

That was at my other clinic location that I am not at today, will post tomorrow when I am back there.

 

[bedrock]

I've had a different experience, but may also be bc I typically send all implants to the functional neurosurgeons at Jefferson who have far more stim expertise than the typical spine surgeon. I've sent two in 3 years for surgical trials. Both fused t10-sacrum. Both did great.

One pending for c spine. Fused anterior and later posterior at c67. Pure neuropathic arm pain failed all I have to offer.


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Agree this works if you have good and interested academic spine surgeons to refer to.

I did when I lived in Taus's area in PA, but here in SoCal, not so much.

 

[giddyup]

Post the pain diagram. And MRI results from L-spine. Those rods and wires are all extraspinal. Same as doing it with CABG wires in way on Xray.

MRIs attached, wires are sublaminar but i still found the leads extremely difficult to drive.