Newswise — Spinal cord stimulators (SCSs) are a useful tool in the treatment of chronic cervical, lumbar, and limb pain. Physicians implant electrodes in the epidural space between the spinal cord and the vertebrae, which send mild electrical impulses to the nerves and can reduce pain. However, the procedure is associated with a risk of rare (but possible) neurological injury. Consequently, experts recommend using preoperative magnetic resonance imaging (MRI) to identify the location of needle entry, lead placement, and review any spinal anatomical pathologies a patient may harbor. After this step, patients progress to an SCS trial before permanent implantation.
Physicians from Pittsburgh, PA, wanted to determine the usefulness of MRI in influencing SCS treatment plans, as MRI is expensive and requires insurance preauthorization. One hypothesis was that patients with specific characteristics might have a greater benefit from the added step.
David Provenzano, MD, Esha Vaidya, and Jason Kilgore, PhD, conducted a retrospective review of patients over a nearly 10-year period and found that MRI did make a difference in enough cases to warrant its continued use. Out of 343 total patients who considered an SCS trial, physicians needed to alter the technique based on an MRI finding for 15 (4.4%), while 10 patients (3%) did not progress to an SCS trial at all based on an MRI finding. MRI was more likely to influence trial progression and technique for patients with cervical pain compared with thoracic/lumbar pain. In addition, older patients were more likely to have moderate to severe cervical and lumbar stenosis, leading to treatment modification. Patients aged 60 and older were more likely to experience moderate-to-severe cervical stenosis.
According to the investigators, “This is the first large-scale study examining the influence of preprocedural MRIs on SCS percutaneous lead trial progression… Since limited patient characteristics were inclusive and associated with a greater risk of stenosis, all patient populations should be considered for preprocedural MRI to identify spinal pathology that may alter SCS percutaneous trials progression.”
The team will present its findings on November 10, at 3:45 pm CT during the 22nd Annual Pain Medicine Meeting in New Orleans, LA. Their abstract “Preoperative Magnetic Resonance Imaging Does Modify Spinal Cord Stimulator Trial Progression and Planning” was selected as one of three “Best of Meeting Abstracts.”
The American Society of Regional Anesthesia and Pain Medicine is a membership society of more than 5,000 health care professionals devoted to advancing evidence-based practice of pain medicine across the pain continuum, from acute pain to chronic pain. Our mission is to advance the science and practice of regional anesthesia and pain medicine to improve patient outcomes through research, education, and advocacy. Our vision is to relieve the global burden of pain. We are committed to integrity, innovation, inclusiveness, service, compassion, and wellness. Learn more at www.asra.com.
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