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Spinal Cord Stimulators In Outpatient Interventional Neuroradiology Practice 2013

Category Interventional Mark Georgy
Jennifer Padwal
Bassem Georgy
Purpose Spinal Cord Stimulation is a known modality for treatment of chronic back and neck pain. Traditionally, spine surgeons and pain physicians perform those procedures.  We are reporting our experience in performing neuromodulation procedures in an out patient interventional radiology practice Materials & Methods Retrospective analysis of medical records of all trial and permanent implantation patients over a period of 4 years was performed after obtaining IRB approval. 45 patients, (32 males and 13 females with median age of 47 years) were included in the study. Primary diagnoses were; 23 cases of failed back or neck surgery syndrome, 12 cases with spinal stenosis, 4 cases of axial pain, 3 cases with reflux sympathetic dystrophy, 1 case of peripheral vascular disease, 1 case of phantom limb and 1case of post concussion syndrome. Results 34 trials were performed in outpatient clinic while 11 trials were performed in hospital outpatient’s settings. Trial periods were 3-7 days. 27 patients (60%) who reported 50% or more pain relief underwent a permanent implantation.  An Interventional neuroradiologist performed 17 implantations, while spine surgeons performed 10 implantations. 23 implants were epidural  (19 lumbar and 4 cervical) while 4 cases were subcutaneous. During follow up period, 3 patients had infections (13%) and required removal of the device and 2 cases (8%) reported lead migration. Conclusion Neuromodulation procedures can be performed safely in an outpatient interventional radiology setting. Complication rates and trial to implant ratio are similar to published data 1, 2 References [1] Cameron T. Safety and efficacy of spinal cord stimulation for treatment of chronic pain: A 20 year literature review J Neurosurg 2004;100:254-267 [2] Mekhail NA, Mathews M, Nageeb F, Guirguis M, Mekhail MN, Cheng J. Retrospective review of 707 cases of spinal cord stimulation: Indications and complications. Pain Practice. 2011; 11:148-153