What has been yalls outcomes with SCS implants?

[FacetiousJoint]

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So far have been in fellowship for 6 months, and my stim patients from july continue to endorse about 60-70% improvement of their pain. many of their trials were 80-90% relief. Mainly been using nevro and medtronic. main diagnoses have been failed back and dpn

What has been yalls experience? main diagnoses that you do scs for? Yall find that the effect kinda plateaus and/or decreases longer the device is in? I remember reading some study that 50% of patients at 1 year will have 50% pain relief.

 

[BobBarker]

So far you have had good results. That might continue with excellent selection going forward for you. I try to explain that the scs isn’t a cure, it is just a helper.

 

[OM1027]

So far have been in fellowship for 6 months, and my stim patients from july continue to endorse about 60-70% improvement of their pain. many of their trials were 80-90% relief. Mainly been using nevro and medtronic. main diagnoses have been failed back and dpn

What has been yalls experience? main diagnoses that you do scs for? Yall find that the effect kinda plateaus and/or decreases longer the device is in? I remember reading some study that 50% of patients at 1 year will have 50% pain relief.

follow up with them in 2 years

 

[Bostonspine]

60-70% is good just make sure it’s not a different problem causing pain especially if the initial diagnosis was neuropathic pain and now they have adjacent segment mechanical pain or hip pain…

 

[CleanUp]

Agreed about patient selection. IMHO there is a sweet spot where one hasn’t had the chronic pain behaviors ossify yet.

 

[Agast]

I think I have a 10% regret/explant rate cumulative over 10 years

 

[clubdeac]

I think I have a 10% regret/explant rate cumulative over 10 years

That’s better than the average

 

[Ronin1]

Here’s our data for Saluda closed loop over 2 years
60 trials 23 to implant
1 explant
10 virtual explants
8 patients using with good benefit
5 using with marginal benefit.

Less than exciting. Definitely much poorer than advertised. Appears to be worse than other products at least in our hands

 

[CleanUp]

Here’s our data for Saluda closed loop over 2 years
60 trials 23 to implant
1 explant
10 virtual explants
8 patients using with good benefit
5 using with marginal benefit.

Less than exciting. Definitely much poorer than advertised. Appears to be worse than other products at least in our hands

Virtual explants meaning they don’t turn it on?

 

[Agast]

That’s better than the average

I do around 10 trials a year with near 100% conversion rate to implant, I don’t offer it to most people because I don’t think they can handle it or I can anticipate where the failure will arise

 

[Ronin1]

Virtual explants meaning they don’t turn it on?

Correct. Just don’t want to go through another surgery to explant

 

[lobelsteve]

Here’s our data for Saluda closed loop over 2 years
60 trials 23 to implant
1 explant
10 virtual explants
8 patients using with good benefit
5 using with marginal benefit.

Less than exciting. Definitely much poorer than advertised. Appears to be worse than other products at least in our hands

Success rate is half of expected placebo rate.
Essentially makes them worse.

 

[RoloTomassi]

I do around 10 trials a year with near 100% conversion rate to implant, I don’t offer it to most people because I don’t think they can handle it or I can anticipate where the failure will arise

Same, probably <10 a year. Just saw a LinkedIn post, couple partners each doing 100/year. Wild.

 

[oreosandsake]

paid off my student loans in 12 months
boat payment covered. got the lambo with cash
closet full of pointy shoes

 

[kstarm]

I don't do stim anymore but my partner does. I think he does a good job of selection, but it seems like everyone to a person states the trial went well and the implant helps but is nowhere near the benefit of the trial. It isn't just him but other docs in the area to. Maybe this is just some bias as patients with stims that are working well perhaps do not bring them up to me, but I have to wonder why there is such a disparity. Perhaps there is just a lot of expectation/placebo involved in this. Stim was the new, best thing when I did fellowship and I started out doing them, but I have been underwhelmed with it over the course of my career, and glad I stopped. I hope others are seeing much better outcomes.

 

[MitchLevi]

I am slowing down my SCS. It underperforms even with meticulous pt selection. I’m not completely off SCS, but it’s just not a great Tx. Really disappointed with it bc cases are fun to do.

 

[clubdeac]

I mean is the risk worth it? I quit doing it several yrs ago and pay hasn’t changed and I sleep better at night

 

[K-hole]

I don't do stim anymore but my partner does. I think he does a good job of selection, but it seems like everyone to a person states the trial went well and the implant helps but is nowhere near the benefit of the trial. It isn't just him but other docs in the area to. Maybe this is just some bias as patients with stims that are working well perhaps do not bring them up to me, but I have to wonder why there is such a disparity. Perhaps there is just a lot of expectation/placebo involved in this. Stim was the new, best thing when I did fellowship and I started out doing them, but I have been underwhelmed with it over the course of my career, and glad I stopped. I hope others are seeing much better outcomes.

They run trial programs that they can’t run for the implant because it will kill the battery life. Dirty little industry secret

 

[Agast]

They run trial programs that they can’t run for the implant because it will kill the battery life. Dirty little industry secret

Even with the rechargeable IPG?

 

[MitchLevi]

They run trial programs that they can’t run for the implant because it will kill the battery life. Dirty little industry secret

I think they all do this

 

[FacetiousJoint]

They run trial programs that they can’t run for the implant because it will kill the battery life. Dirty little industry secret

This is what ive heard too as well. I wonder if theres a way to get them to run the trial program the whole time and end up swapping the ipg if needed. it shouldnt make a difference if the battery is rechargable

 

[painisfear]

I’ve had good experience. I’m very selective.

I require 80% or more relief from trial before implant.

I require smoking cessation and opioid cessation before implant and explain how resuming either will worsen their outcomes and why.

I don’t use Nevro. I found the biggest trial to perm relief discrepancy with Nevro and in my area they also have the worst rep support. I have explanted more Nevro than anything else.

I like Medtronic for older people with more of a low back pain profile without the radicular pattern. I feel like DTM works surprisingly well. I like Medtronic also in scenarios where I wouldn’t want to do a lead revision to maintain MRI conditionality if there is an impedance issue (old patients who I don’t want to reoperate on).

I like Boston for the more radicular pain profiles.

I think if you are selective and transparent with patients you can have a good stim program.

In fellowship it’s hard to get a Birds Eye view. Also so much of your experience will depend on your attendings experience and practice style.

One thing to always remember is that stim helps neuropathic pain (nerve and some disc) and not other kinds of pain. So you may still need to manage facet arthritis and SI joint pain with other tools.

 

[mille125]

Here’s our data for Saluda closed loop over 2 years
60 trials 23 to implant
1 explant
10 virtual explants
8 patients using with good benefit
5 using with marginal benefit.

Less than exciting. Definitely much poorer than advertised. Appears to be worse than other products at least in our hands

SCS is general helps many patients but way more poorer than advertised by most with way more complications than advertised as well..

 

[interjectionreflection]

Here’s our data for Saluda closed loop over 2 years
60 trials 23 to implant
1 explant
10 virtual explants
8 patients using with good benefit
5 using with marginal benefit.

Less than exciting. Definitely much poorer than advertised. Appears to be worse than other products at least in our hands

Does this include DRG?

 

[Ronin1]

Does this include DRG?

This is just our Saluda data. I actually stopped doing DRG several years ago. Too many lead migrations and multiple revisions and less than optimal results as well.