Katie Rousseau Erich Richter, M.D. LSU Health Sciences Center, New Orleans.

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Presentation transcript:

Katie Rousseau Erich Richter, M.D. LSU Health Sciences Center, New Orleans

Spinal Cord Stimulation Important treatment for chronic neuropathic back and leg pain SCS has traditionally been more effective for the treatment of leg pain than for low back pain 1

Current techniques Clinical efficacy depends on paresthesia coverage of the painful area There are several techniques for implantation Awake placement General anesthesia with fluroscopy General anesthesia with EMG mapping

Objective If a patient has low back paresthesia with a specific set of stimulation parameters when prone, how likely are they to still have low back paresthesia with the same stimulation parameters when they are sitting? Determine the predictive value of prone low back paresthesia for sitting low back paresthesia

Methods Patients were examined at routine follow up after implantation of permanent paddle lead A series of programming combinations was tested to determine which combinations gave low back paresthesia coverage while prone These combinations were then tested in the sitting position to determine if they still gave low back coverage 8 males, 3 females, ages 44 to 81

Example 1: Prone

Example 1: Sitting

Legend: L: left R: right 0: no paresthesia 1: paresthesia present Example 1: Graph

Legend: L: left R: right 0: no paresthesia 1: paresthesia present Example 2: Graph

Results Only 58.1% of the settings that generated paresthesia in the low back in the prone position also generated the same coverage while upright However, successful coverage could be reliably found in all patients when using an electrode with coverage redundancy

Conclusions Specific electrode combinations producing paresthesia in the low back in the prone position are unreliable at producing the same pattern when sitting This may have implications for intraoperative physiologic mapping However, it appears possible to capture the low back with moderate programming changes

Acknowledgements Funded by Alpha Omega Alpha’s Carolyn L. Kuckein Student Research Fellowship

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