The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform

Bryan C Hoelzer - One of the best experts on this subject based on the ideXlab platform.

  • utilization of leads after permanent implant in Spinal Cord Stimulator systems
    Pain Practice, 2018
    Co-Authors: Rebecca A Sanders, Markus A Bendel, Halena M Gazelka, Jason S Eldrige, Bryan C Hoelzer, Susan M Moeschler, Matthew J Pingree, Tim J Lamer, Thomas P Pittelkow, David W Mauck
    Abstract:

    Objective The goal of this study was to determine the frequency and clinical indications associated with implantation of single versus dual percutaneous lead Spinal Cord Stimulator (SCS) systems and to look further into how these leads are utilized for treatment. Materials and Methods A retrospective cohort analysis of all patients undergoing SCS implantation between January 2001 and December 2013 with a minimum of two year clinical follow-up was performed. Number of trial and implanted leads was reCorded. For patients with dual lead systems, it was noted if and when the second lead was used, along with the clinical indication for lead activation. Results Of the 259 patient cohort, 15.8% (n=41) patients underwent placement of a single lead system, 83.0% (n=215) underwent placement of a dual lead system, and 1.2% (n=3) underwent placement of three lead systems. Placement of dual lead systems was similar among all indication groups. Of those patients with a dual lead system in place, 88.1% utilized both leads and average time to programming of the second lead was 2.3 months. Most common reason to activate the second lead was inadequate stimulation coverage. Five of the 41 patients with single-lead systems underwent an additional surgery to implant a second lead due to inadequate stimulation with one lead. Conclusions To our knowledge this is the first descriptive analysis of the frequency of single and dual lead Spinal Cord Stimulator systems. This report indicates that dual lead systems are most often placed and both leads are required for optimal patient therapy. This article is protected by copyright. All rights reserved.

  • Spinal Cord Stimulator related infections findings from a multicenter retrospective analysis of 2737 implants
    Neuromodulation, 2017
    Co-Authors: Markus A Bendel, Bryan C Hoelzer, Thomas P Pittelkow, Travis G Obrien, Timothy R Deer, Shrif Costandi, David R Walega, Gerges Azer, Salim M Hayek, Zhen Wang
    Abstract:

    Introduction Surgical site infection is a potential complication of Spinal Cord Stimulator (SCS) implantation. Current understanding of the epidemiology, diagnosis, and treatment of these infections is based largely on small clinical studies, many of which are outdated. Evidence-based guidelines for management of SCS-related infections thus rely instead on expert opinion, case reports, and case series. In this study, we aim to provide a large scale retrospective study of infection management techniques specifically for SCS implantation. Methods A multicenter retrospective study of SCS implants performed over a seven-year period at 11 unique academic and non-academic institutions in the United States. All infections and related complications in this cohort were analyzed. Results Within our study of 2737 SCS implant procedures, we identified all procedures complicated by infection (2.45%). Localized incisional pain and wound erythema were the most common presenting signs. Laboratory studies were performed in the majority of patients, but an imaging study was performed in less than half of these patients. The most common causative organism was Staphylococcus aureus and the IPG pocket was the most common site of an SCS-related infection. Explantation was ultimately performed in 52 of the 67 patients (77.6%). Non-explantation salvage therapy was attempted in 24 patients and was successful in resolving the infection in 15 patients without removal of SCS hardware components. Discussion This study provides current data regarding SCS related infections, including incidence, diagnosis, and treatment.

  • Spinal Cord Stimulator implant infection rates and risk factors a multicenter retrospective study
    Neuromodulation, 2017
    Co-Authors: Bryan C Hoelzer, Markus A Bendel, Jason S Eldrige, Timothy R Deer, Shrif Costandi, David R Walega, Gerges Azer, Zhen Wang, Wenchun Qu, Steven M Falowski
    Abstract:

    Objectives Spinal Cord stimulation is an evidence-based treatment for a number of chronic pain conditions. While this therapy offers improvement in pain and function it is not without potential complications. These complications include device failure, migration, loss of therapeutic paresthesia, and infection. This article looked to establish a modern infection rate for Spinal Cord Stimulators, assess the impact of known risk factors for surgical site infections and to determine the impact of certain preventative measures on the rate of infection. Methods After institutional review board approval, a multisite, retrospective review was conducted on 2737 unique implants or revisions of SCS systems. Patient demographics, risk factors including diabetes, tobacco use, obesity, revision surgery, trial length, implant location, implant type, surgeon background, prophylactic antibiotic use, utilization of a occlusive dressing, and post-operative antibiotic use were reCorded and analyzed. Results The overall infection rate was 2.45% (n = 67). Diabetes, tobacco use, and obesity did not independently increase the rate of infection. Revision surgeries had a trend toward higher infection rate; however, this did not meet statistical significance. There was no difference in the rate of infection between implants performed by physicians of different base specialties, cylinder leads vs. paddle leads, or between different prophylactic antibiotics. Implants performed at academic centers had a higher rate of infection when compared to implants performed in nonacademic settings. When patients received an occlusive dressing or post-operative antibiotics they had a lower rate of infection. Conclusions The infection rate (2.45%) reported in this study is lower than the previously reported rates (3–6%) and are on par with other surgical specialties. This study did not show an increased rate of infection for patients that used tobacco, had diabetes or were obese. It's possible that given the low overall infection rate a larger study is needed to establish the true impact of these factors on infection. In addition, this study did not address the impact of poorly controlled diabetes mellitus (elevated hemoglobin A1c) vs. well-controlled diabetes. It can be concluded from this study that utilizing an occlusive dressing over the incision in the post-operative period decreases the rate of infection and should become the standard of care. This study also demonstrated the positive impact of post-operative antibiotics in decreasing the rate of infection. Studies in other surgical specialties have not shown this impact which would suggest that further research is needed.

  • bleeding complications in patients undergoing percutaneous Spinal Cord Stimulator trials and implantations
    Pain Medicine, 2016
    Co-Authors: Susan M Moeschler, Markus A Bendel, Halena M Gazelka, Jason S Eldrige, William D Mauck, Tim J Lamer, Nafisseh S Warner, Matthew A Warner, Daryl J Kor, Bryan C Hoelzer
    Abstract:

    Introduction. Spinal Cord Stimulators (SCS) are indicated for the management of multiple pain states with strong evidence. Recent guidelines recommend discontinuing aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) for the described procedures. The goal of this investigation is to assess the rate of bleeding and neurologic sequelae in patients undergoing SCS trials and implantation. Methods. This is a retrospective review from 2005 through 2014 of all patients 18 years or older undergoing the following procedures: Percutaneous SCS implantations, SCS revisions, and SCS trials. Baseline characteristics, antiplatelet and anticoagulation medications, coagulation parameters, and procedural details were extracted. The primary outcome was the presence of a bleeding complication within 31 days of the procedure requiring emergency medicine, neurology, or neurosurgical evaluation. The neurological complication was independently categorized for its potential relationship to procedural bleeding, and periprocedural red blood cell transfusion requirements were analyzed as a secondary outcome. Results. A total of 642 percutaneous SCS procedures were performed on 421 unique patients, including 346 SCS trials, 255 SCS implantations, and 41 revision surgeries. Patients had received aspirin or NSAIDs within 7 days of needle placement for 101 procedures (15.7%). There were no bleeding or neurological complications identified in this cohort. Conclusion. Although the incidence of epidural hematoma is low, the development of bleeding complications following SCS lead placement can be devastating. In the present investigation, we identified no cases of epidural hematoma following percutaneous SCS lead placement, including more than 100 patients receiving aspirin or NSAIDs. Future investigations with larger numbers are needed to better define the relationships between periprocedural aspirin and NSAID utilization and bleeding complications.

  • Spinal Cord Stimulator explantation for magnetic resonance imaging a case series
    Neuromodulation, 2015
    Co-Authors: Susan M Moeschler, Michael W Hooten, Rebecca A Sanders, Bryan C Hoelzer
    Abstract:

    Introduction Spinal Cord Stimulator (SCS) systems are implanted to treat pain conditions such as neuropathic, radicular, and ischemic pain syndromes. Prior to July 2013, SCS systems were not magnetic resonance imaging (MRI) compatible due to the risk of thermal injury at the site of the leads and generator. Although there are some case reports of patients undergoing MRI studies with SCS systems in place, these Stimulators are frequently explanted when clinical care has necessitated an MRI. The purpose of this case series is to discuss the role of SCS explantation in order to acquire an MRI. Methods This study was performed at a tertiary academic pain medicine clinic. After exempt status was obtained via the institutional review board, patients were identified via the use of Common Procedural Terminology codes for implantable devices. A chart review was performed to identify all patients >18 years of age who had a lumbar or thoracic dorsal column SCS implanted during January 2001–December 2011. The charts were then followed to identify any patients who underwent a surgery for explantation of the device. Data collection included the total number of patients undergoing permanent SCS implantation, the total number of explantation of these devices, patient demographic factors, indication for SCS implantation, incidence of revisions and the indication, duration between implantation and explant of the device, and indication for explantation. Results During the time between 2001 and 2011, 199 patients were identified who underwent a thoracic or lumbar SCS implant after a successful trial. Among 199 implants, 33 devices were explanted, and of these, four were explanted due to the primary need for an MRI scan.

Matthew A Howard - One of the best experts on this subject based on the ideXlab platform.

  • risk factors and survival analysis of Spinal Cord Stimulator explantation
    Neuromodulation, 2021
    Co-Authors: Mark C Dougherty, Saul Wilson, George T Gillies, Matthew A Howard, Royce W Woodroffe, Ryan M Carnahan
    Abstract:

    Objective The treatment failure rate for Spinal Cord Stimulators (SCS) remains unacceptably high, with reports of removal in up to 30% of patients. The purpose of this study is to perform survival and multivariate regression analyses of patients who have undergone SCS explantation in order to identify patient characteristics that may predict treatment failure. Materials and methods We identified 253 patients who underwent SCS placement using current procedural terminology codes in a private health insurance data base spanning 2003-2016. Patient demographics, opioid use, surgical indications, as well as comorbidities were noted. At least 6 months of continuous claims data before and after implantation were required for inclusion. Patients who underwent explantation were defined as those who underwent removal without replacement within 90 days and had at least 90 days of continuous insurance eligibility following removal. Those who underwent removal for infectious reasons were identified with corresponding diagnosis codes. Results Of the 252 patients who met the inclusion criteria, 17 (6.7%) underwent SCS explantation. Median follow-up time was 2.0 years. Of those who had their system explanted, six patients (2.8%) had their systems removed for infection and 11 (4.3%) for noninfectious reasons. Bivariate analysis revealed that younger age and tobacco use were associated with an increased likelihood of explantation. The Cox proportional hazards analysis demonstrated that younger age, tobacco use, and the presence of "other" mental health disorders were predictive of explantation. Conclusions In a cohort of SCS patients from multiple institutions, this study demonstrates that explantation for noninfectious reasons is more likely in younger patients, tobacco users, and those with certain psychiatric conditions. With an estimated 10% of patients opting to have their devices removed within 5 years of implantation, refining the ability of clinicians to predict who will see benefit from SCS treatment remains necessary.

  • in vivo testing of a prototype intradural Spinal Cord Stimulator in a porcine model
    World Neurosurgery, 2020
    Co-Authors: Marshall T Holland, Douglas C Fredericks, George T Gillies, Katherine N Gibsoncorley, Royce W Woodroffe, Scott C Seaman, Christopher K Kovach, Matthew A Howard
    Abstract:

    Background Chronic midline low back pain is the number one reason for disability in the United States despite the prolific use of medical and surgical interventions. Notwithstanding the widespread use of epidural Spinal Cord Stimulators (SCSs), there remains a large portion of the population with inadequate pain control thought to be because of the limited volume of stimulated neural tissue. Intradural SCSs represent an underexplored alternative strategy with the potential to improve selectivity, power efficiency, and efficacy. We studied and carried out development of an intradural form of an SCS. Herein we present the findings of in vivo testing of a prototype intradural SCS in a porcine model. Methods Six female juvenile pigs underwent surgical investigation. One control animal underwent a laminectomy only, whereas the 5 other animals had implantation of an intradural SCS prototype. One of the prototypes was fully wired to enable acute stimulation and concurrent electromyographic reCordings. All animals underwent terminal surgery 3 months postimplantation, with harvesting of the Spinal column. Imaging (microcomputed tomography scan) and histopathologic examinations were subsequently performed. Results All animals survived implantation without evidence of neurologic deficits or infection. Postmortem imaging and histopathologic examination of the Spinal column revealed no evidence of Spinal Cord damage, cerebroSpinal fluid fistula formation, abnormal bony overgrowth, or dural defect. Viable dura was present between the intra- and extradural plates of the device. Electromyographic reCordings revealed evoked motor units from the Stimulator. Conclusions Chronically implanted intradural device in the porcine model demonstrated safety and feasibility for translation into humans.

  • biomechanical performance of an ovine model of intradural Spinal Cord stimulation
    Journal of Medical Engineering & Technology, 2014
    Co-Authors: Sina Safayi, N D Jeffery, Douglas C Fredericks, Stephanus V Viljoen, Brian D Dalm, Chandan G Reddy, Saul Wilson, George T Gillies, Matthew A Howard
    Abstract:

    The authors are developing a novel type of Spinal Cord Stimulator, designed to be placed directly on the pial surface of the Spinal Cord, for more selective activation of target tissues within the dorsal columns. For pre-clinical testing of the device components, an ovine model has been implemented which utilizes the agility and flexibility of a sheep’s cervical and upper thoracic regions, thus providing an optimal environment of accelerated stress-cycling on small gauge lead wires implanted along the dorsal Spinal columns. The results are presented of representative biomechanical measurements of the angles of rotation and the angular velocities and accelerations associated with the relevant head, neck and upper back motions, and these findings are interpreted in terms of their impact on assessing the robustness of the Stimulator implant systems.

  • soft coupling suspension system for an intradural Spinal Cord Stimulator biophysical performance characteristics
    Journal of Applied Physics, 2013
    Co-Authors: Hiroyuki Oya, Sina Safayi, N D Jeffery, Stephanus V Viljoen, Brian D Dalm, Chandan G Reddy, George T Gillies, Jessleen Kanwal, Matthew A Howard
    Abstract:

    We have characterized the mechanical compliance of an improved version of the suspension system used to position the electrode-bearing membrane of an intradural neuromodulator on the dorsal pial surface of the Spinal Cord. Over the compression span of 5 mm, it exhibited a restoring force of 2.4 μN μm−1 and a mean pressure of 0.5 mm Hg (=66 Pa) on the surface below it, well within the range of normal intrathecal pressures. We have implanted prototype devices employing this suspension and a novel device fixation technique in a chronic ovine model of Spinal Cord stimulation and found that it maintains stable contact at the electrode-pia interface without lead fracture, as determined by measurement of the inter-contact impedances.

  • optimization of intradural Spinal Cord Stimulator designs via analysis of thoracic spine imaging data
    Journal of Medical and Biological Engineering, 2013
    Co-Authors: Stephanus V Viljoen, Brian D Dalm, Chandan G Reddy, Saul Wilson, George T Gillies, Charles Smittkamp, Matthew A Howard
    Abstract:

    Axial magnetic resonance images of the thoracic Spinal Cord of 50 patients are analyzed in order to measure the length of the dorsal arc span between the dorsal root entry zones for the purpose of optimizing the mechanical design dimensions of the Human Spinal Cord Modulation System (HSCMS), which delivers electrical stimuli directly to the Spinal Cord. Two mathematical approaches are used to assess the data, with validation of the results conducted via a direct physical measurement using a magnified image. Results show that the nominal value of the arc length is 6.7 ± 1.0 mm (1 σ), with high and low values of 8.8 and 5.1 mm, respectively. The mean radius of the Spinal Cord was found to be 3.6 ± 0.5 mm. Taking into account previously reported measurements, it is suggested that values at the high end of this range be used for further morphometric studies of the Cord in the thoracic region. The implications of these findings on the design of the HSCMS are discussed.

Steven M Falowski - One of the best experts on this subject based on the ideXlab platform.

  • implantation of a thoracic Spinal Cord Stimulator paddle electrode and generator under general anesthesia with intraoperative neuromonitoring 2 dimensional operative video
    Operative Neurosurgery, 2019
    Co-Authors: Lauren E Stone, Steven M Falowski
    Abstract:

    Spinal Cord stimulation is a well-established and effective therapy in the treatment of pain. Proper patient selection and accurate lead placement are paramount in its success. Placement is a multifaceted process requiring proper paddle placement, a well thought out generator placement and appropriate means to limit complications and enhance success. Several intraoperative techniques maximize outcomes, including removal of the superior portion of the inferior level's spinous process for paddle access into the epidural space, generator pocket placement in a location that limits patient discomfort, a strain relief loop at the thoracic incision to prevent lead fractures and allow for full Spinal flexibility, generator placement parallel to the body and secured in the pocket to prevent unwanted movement, and intraoperative neuromonitoring for patient comfort and more accurate lead placement compared to X-ray alone or awake placement. This case demonstrates these key elements of intraoperative technique in a candidate with the most common indication for Spinal Cord Stimulator placement-postlaminectomy syndrome-underscoring the ease and viability of this procedure in the appropriate patient population in a means that reduces future complications and adverse events while maximizing success.  Full patient consent for video-reCording and subsequent use for research purposes was attained. All patient identifiers have been removed for the purpose of patient confidentiality.

  • Spinal Cord Stimulator implant infection rates and risk factors a multicenter retrospective study
    Neuromodulation, 2017
    Co-Authors: Bryan C Hoelzer, Markus A Bendel, Jason S Eldrige, Timothy R Deer, Shrif Costandi, David R Walega, Gerges Azer, Zhen Wang, Wenchun Qu, Steven M Falowski
    Abstract:

    Objectives Spinal Cord stimulation is an evidence-based treatment for a number of chronic pain conditions. While this therapy offers improvement in pain and function it is not without potential complications. These complications include device failure, migration, loss of therapeutic paresthesia, and infection. This article looked to establish a modern infection rate for Spinal Cord Stimulators, assess the impact of known risk factors for surgical site infections and to determine the impact of certain preventative measures on the rate of infection. Methods After institutional review board approval, a multisite, retrospective review was conducted on 2737 unique implants or revisions of SCS systems. Patient demographics, risk factors including diabetes, tobacco use, obesity, revision surgery, trial length, implant location, implant type, surgeon background, prophylactic antibiotic use, utilization of a occlusive dressing, and post-operative antibiotic use were reCorded and analyzed. Results The overall infection rate was 2.45% (n = 67). Diabetes, tobacco use, and obesity did not independently increase the rate of infection. Revision surgeries had a trend toward higher infection rate; however, this did not meet statistical significance. There was no difference in the rate of infection between implants performed by physicians of different base specialties, cylinder leads vs. paddle leads, or between different prophylactic antibiotics. Implants performed at academic centers had a higher rate of infection when compared to implants performed in nonacademic settings. When patients received an occlusive dressing or post-operative antibiotics they had a lower rate of infection. Conclusions The infection rate (2.45%) reported in this study is lower than the previously reported rates (3–6%) and are on par with other surgical specialties. This study did not show an increased rate of infection for patients that used tobacco, had diabetes or were obese. It's possible that given the low overall infection rate a larger study is needed to establish the true impact of these factors on infection. In addition, this study did not address the impact of poorly controlled diabetes mellitus (elevated hemoglobin A1c) vs. well-controlled diabetes. It can be concluded from this study that utilizing an occlusive dressing over the incision in the post-operative period decreases the rate of infection and should become the standard of care. This study also demonstrated the positive impact of post-operative antibiotics in decreasing the rate of infection. Studies in other surgical specialties have not shown this impact which would suggest that further research is needed.

  • neuromonitoring protocol for Spinal Cord Stimulator cases with case descriptions
    International Journal of Academic Medicine, 2016
    Co-Authors: Steven M Falowski, Andres Dianna
    Abstract:

    Spinal Cord stimulation (SCS) relies on the ability to create an overlap of paresthesia on the painful regions. Electrode implantation has historically been performed with awake intraoperative testing to allow the patient to report on the device-induced paresthesia. More recently, the use of neuromonitoring has come into favor and can be used for SCS placement, while the patient remains fully anesthetized throughout the surgery. This is a critical evaluation of the neuromonitoring technique and protocol with an in-depth description of neuromonitoring for SCS placement using electro-myography (EMG) responses in both cervical and thoracic electrode placement. There is an explanation for the interpretation of the EMG responses, as well as case reports of two patients. Neuromonitoring is used to determine myotomal coverage, as a marker that corresponds with dermatomal coverage. This article demonstrates some of the critical steps for both the surgeon and neuromonitoring group to implement this technique, as well as the clinical results of paresthesia coverage in patients. This protocol can be utilized in implementing neuromonitoring into a practice for those implanting SCS systems. The following core competencies are addressed in this article: Medical knowledge, patient care, practice-based learning and improvement, system-based practice, interpersonal and communication skills. This article addresses the gap in knowledge base to implement an approach to improve patient care and outcome.

  • Spinal Cord injury induced by a cervical Spinal Cord Stimulator
    Neuromodulation, 2011
    Co-Authors: Steven M Falowski, Yinn Cher Ooi, Arvind Sabesan, Ashwini Sharan
    Abstract:

    Objective:  The use of cervical Spinal Cord Stimulators for the treatment of refractory neck and upper extremity pain is widely accepted and growing in use as a treatment modality. This case highlights a previously unreported potential complication of Spinal Cord Stimulators. Methods:  Analysis of a patient with a cervical Spinal Cord Stimulator presenting with a Spinal Cord injury. Patient was followed from presentation in the emergency room until 1-year follow-up in the office. Results:  The patient in this case presented after a fall and sustained a cervical Spinal Cord injury induced by the electrodes of her Spinal Cord Stimulator working as a space occupying mass. Conclusion:  As more patients are undergoing implantation of Spinal Cord Stimulators we must be aware of the long-term risks that can be encountered.

Antonios Mammis - One of the best experts on this subject based on the ideXlab platform.

  • thoracic radiculopathy following Spinal Cord Stimulator implantation treated with corticosteroids
    World Neurosurgery, 2017
    Co-Authors: Ritam Ghosh, Ryan Holland, Antonios Mammis
    Abstract:

    Introduction Spinal Cord stimulation has been used since 1967 to manage chronic neuropathic pain. Although effective, the literature describes the complication rate to be as high as 35%. One rare complication following Spinal Cord Stimulator (SCS) implantation is the development of radicular pain. We present a case series of 2 patients implanted with SCSs who developed thoracic radiculopathy following implantation that resolved with corticosteroids. Case Details Although this complication was previously thought to require surgical intervention, this case series describes the use of corticosteroids to resolve postimplantation thoracic radiculopathy. Two patients were studied in this case series who received permanent thoracic implantation of a paddle lead SCS. Several days later, both developed back pain radiating toward the umbilicus in a dermatomal pattern consistent with thoracic radiculopathy. Corticosteroids were administered to relieve this pain. One received 6 mg dexamethasone intravenously every 6 hours followed by an oral dexamethasone taper for 1 week. The other was treated with an oral methylprednisolone taper for 2 weeks. Results Upon follow-up, both patients no longer complained of the thoracic radiculopathy and were satisfied with the pain relief the Stimulators provided. Conclusion In conclusion, postsurgical radicular pain is a rare but troubling complication of SCS implantation. In order to avoid further surgical complications or the need to explant a device that provides satisfactory paresthesia coverage, pharmacologic management is desirable. This case series has demonstrated that the use of corticosteroids can effectively resolve postimplantation thoracic radicular pain in a specific subgroup of patients.

  • thoracic radiculopathy following Spinal Cord Stimulator placement case series
    Neuromodulation, 2013
    Co-Authors: Antonios Mammis, Christopher Bonsignore, Alon Y Mogilner
    Abstract:

    Objective The clinical entity of thoracic radiculopathy following Spinal Cord Stimulator (SCS) placement has not been previously described. Materials and Methods A retrospective review of prospectively acquired data on 172 patients, having undergone thoracic SCS placement at our institution, was performed. In addition, four patients were implanted at outside institutions, and were referred for revision. We examine our early experience with placement of thoracic SCS in surgically treated patients with chronic pain and 15 associated specific postoperative radicular pain complications along respective thoracic dermatomes. We postulate that preexisting thoracic Spinal pathology affords less compliance in the placement of larger paddles, and subsequent radicular pain in a band-like abdominal fashion. Results A syndrome of thoracic radiculopathy, presenting as intractable lower thoracic or abdominal wall pain occurring in the immediate postoperative period, was identified in 15 patients. These patients subsequently underwent revision surgery, with either a more extensive laminectomy to further decompress the dorsal nerve roots or lead removal, both of which resulted in near immediate relief of symptoms. Conclusions Thoracic radiculopathy may occur following SCS paddle lead placement. This clinical syndrome is characterized by its immediate postoperative development, band-like thoracic or abdominal pain pattern, severe pain that both overwhelms the incisional pain and is refractory to medications, and absence of motor deficit. The lateral placement of paddle leads increases the risk of radicular symptoms. Preoperative thoracic spine magnetic resonance imaging may be helpful in identifying patients who may be susceptible to this syndrome.

Lawrence Poree - One of the best experts on this subject based on the ideXlab platform.

  • epidural hematomas after removal of percutaneous Spinal Cord Stimulator trial leads two case reports
    Regional Anesthesia and Pain Medicine, 2014
    Co-Authors: Curren E Giberson, Judith Barbosa, Elizabeth S Brooks, Gail L Mcglothlen, Eric Grigsby, James J Kohut, Linda L Wolbers, Lawrence Poree
    Abstract:

    Objective We report 2 cases of Spinal epidural hematoma formation after the removal of percutaneous Spinal Cord Stimulator trial leads and discuss the possible etiologies of these complications. Case Report Two patients developed Spinal epidural hematomas shortly after removal of their percutaneous trial leads and required multilevel laminectomies for evacuation of the hematoma. Patient 1 reported taking aspirin the morning that his leads were pulled, whereas patient 2 had not taken aspirin in the 7 days before commencing his trial. There were 2 days between identification and evacuation of patient 1’s hematoma, and he did not fully recover from the injury to his Spinal Cord. Patient 2 underwent surgery immediately with complete resolution of his symptoms. Conclusions Currently, the neuromodulation community ascribes to the American Society of Regional Anesthesia and Pain Medicine guidelines, which state that nonsteroidal anti-inflammatory drugs do not significantly increase the risk for epidural hematoma with neuraxial anesthesia and, therefore, there is no need to discontinue these drugs before epidural or Spinal anesthesia. We suggest that these guidelines may not be appropriate for neuromodulatory techniques that likely subject the surrounding vasculature to more trauma than neuraxial anesthesia. We recommend discontinuing nonsteroidal anti-inflammatory drugs, particularly aspirin, before neuromodulation procedures. Further investigation will establish a timeframe for holding these drugs to optimize patient safety.