The Use of Intraoperative Electrophysiology for the Placement of Spinal Cord Stimulator Paddle Leads Under General Anesthesia

Mammis, Antonios; Mogilner, Alon Y.

doi:10.1227/neu.0b013e318232ff29

Cited by 28 publications

(49 citation statements)

References 22 publications

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“…The use of free-run EMG to evaluate mediolateral lead positioning has been described by several groups, with retrospective data supporting its efficacy for SCS implantation [14,15,17,18] . Stimulation of the dorsal columns by the epidural lead elicits EMG activity in corresponding muscle groups through two proposed mechanisms -direct ventral root activation or indirect synaptic activation of the anterior horn [15,32] .…”

Section: Electromyographymentioning

confidence: 99%

“…Stimulation of the dorsal columns by the epidural lead elicits EMG activity in corresponding muscle groups through two proposed mechanisms -direct ventral root activation or indirect synaptic activation of the anterior horn [15,32] . Regardless of origin, EMG activity can be visually evaluated for symmetry and used to make an accurate prediction of laterality [15] .…”

Section: Electromyographymentioning

confidence: 99%

“…The literature contains re- ports of all-cause reoperation rates for SCS ranging from 14.94 to 31% [3,15,18] . Over the course of our experience, surgeon preference shifted to favor a percutaneous approach over laminectomy with paddle leads for cervical SCS.…”

Section: Reoperationmentioning

confidence: 99%

mentioning

confidence: 99%

“…This technique can be hindered by sedation-related agitation or disorientation, hearing deficits and assorted language barriers [14,15] . Secondly, this technique may cause high stress levels for the patient and the operative team, predisposes to patient movement and limits airway protection in prone position [14][15][16][17] . Retrospective data suggest that intraoperative neurophysiological monitoring (IOM) may provide sufficient feedback to ensure optimal lead placement [14][15][16][17][18][19] .…”

mentioning

confidence: 99%

See 4 more Smart Citations

A Prospective Study of the Intra- and Postoperative Efficacy of Intraoperative Neuromonitoring in Spinal Cord Stimulation

Roth

Lange

Haller

et al. 2015

Stereotact Funct Neurosurg

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Background: Accurate lead placement is critical for spinal cord stimulation (SCS) efficacy. The traditional gold standard of awake placement is often technically difficult. While there is retrospective evidence supporting the use of intraoperative neurophysiological monitoring (IOM) as an alternative, a prospective assessment has not yet been performed. Objective: To prospectively evaluate pain and functionality outcomes for IOM-guided SCS, validate two IOM modalities as a means to lateralize lead placement and assess whether IOM can be useful for postoperative programming. Methods: A total of 73 patients were implanted with SCS using electromyography (EMG) and somatosensory-evoked potential collision studies (SSEP-CS) to verify lead placement. Patient pain and function were assessed through serial administration of several validated questionnaires. Stimulation parameters at 6 months were documented. Results: Statistically significant (p < 0.05) improvements were observed in the McGill Pain Questionnaire, Oswestry Disability Index, Pain Catastrophizing Scale, and Visual Analog Scale. EMG and SSEP-CS appropriately lateralized leads in 65/73 (89.0%) and 40/58 (69.0%) cases, respectively. EMG predicted active contacts in use at follow-up with 82.7% sensitivity. Conclusions: We provide prospective evidence that IOM can be used to verify SCS placement. Additionally, EMG may help to streamline device programming and thereby improve outcomes by predicting the ideal stimulation contacts in many cases.

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Section: Electromyographymentioning

confidence: 99%

Section: Electromyographymentioning

confidence: 99%

Section: Reoperationmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

A Prospective Study of the Intra- and Postoperative Efficacy of Intraoperative Neuromonitoring in Spinal Cord Stimulation

Roth

Lange

Haller

et al. 2015

Stereotact Funct Neurosurg

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Cervical Spinal Cord Stimulation: A Review

Krog,

Maloney,

Pew

et al. 2023

Curr Pain Headache Rep

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Percutaneous Spinal Cord Stimulation Lead Placement Under Deep Sedation and General Anesthesia

et al. 2021

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Introduction: Spinal cord stimulation (SCS) is a commonly utilized therapy for the treatment of neuropathic pain conditions. The Neurostimulation Appropriateness Consensus Committee (NACC) has recommended that the placement of percutaneous SCS leads be performed in an awake patient capable of providing feedback. It is not currently known how commonly this recommendation is adhered to by physicians in clinical practice. This article presents the findings of a survey designed to answer this important question. Methods:We conducted a survey of the active membership of the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the Spine Intervention Society (SIS) regarding practice patterns with SCS therapy. We analyzed the percent of respondents who indicated that they use deep sedation and general anesthesia during SCS placement as well as any reported complications. Results: Many practitioners frequently utilize deep sedation as well as general anesthesia when performing SCS implants. Our findings demonstrate that 77% of physicians reported that they utilize deep sedation for permanent SCS implants at times, and 45% of physicians

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The Use of Intraoperative Electrophysiology for the Placement of Spinal Cord Stimulator Paddle Leads Under General Anesthesia

Abstract: The use of intraoperative electrophysiology for the placement of spinal cord stimulation paddle leads under general anesthesia is a safe and efficacious alternative to awake surgery.

Cited by 28 publications

References 22 publications

A Prospective Study of the Intra- and Postoperative Efficacy of Intraoperative Neuromonitoring in Spinal Cord Stimulation

A Prospective Study of the Intra- and Postoperative Efficacy of Intraoperative Neuromonitoring in Spinal Cord Stimulation

Cervical Spinal Cord Stimulation: A Review

Percutaneous Spinal Cord Stimulation Lead Placement Under Deep Sedation and General Anesthesia

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