Neuromodulation : journal of the International Neuromodulation Society
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Randomized Controlled Trial
Predictors of implantable pulse generator placement after sacral neuromodulation: who does better?
Numerous studies have documented a relationship between provider variables, including surgeon volume and specialty, and outcomes for surgical procedures. In this study we analyzed claims data from a Medicare database to analyze outcomes of sacral neuromodulation (SNM) with respect to both provider and patient factors. ⋯ The rate of IPG implantation after SNM was greater among high-volume providers. Women had better outcomes than men. Further research may better define the relationship between outcomes of sacral neuromodulation and specific etiology of voiding dysfunction.
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The objective of this investigation was to evaluate magnetic resonance imaging (MRI) issues (magnetic field interactions, MRI-related heating, and artifacts) for a wirelessly powered lead used for spinal cord stimulation (SCS). ⋯ These findings demonstrated that it is acceptable for a patient with this wirelessly powered lead used for SCS to undergo MRI under the conditions utilized in this investigation and according to other necessary guidelines. Artifacts seen on magnetic resonance images may pose possible problems if the area of interest is in the same area or close to this lead.
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Spinal cord stimulation (SCS) has become an evidence-based treatment for a variety of chronic pain disorders. A key step in appropriate patient selection and long-term outcome predictability is a percutaneous screening trial of stimulation. Occasionally, a trial cannot be adequately completed with a percutaneous electrode. Rather than depriving this therapy from these patients, the authors have developed a program providing surgically implanted paddle-lead screening trials of SCS. ⋯ Surgically implanted paddle-lead screening trials of SCS can be used safely and effectively in those patients in which an adequate percutaneous-electrode trial cannot be completed. Results are similar to those seen with standard percutaneous screening trials. A systematic approach to surgical-paddle screening trials of SCS has not been previously reported.
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The objective of this narrative review is to discuss the clinical implications of position-related changes in spinal cord stimulation and technological improvements to better meet patient needs. ⋯ A new type of spinal cord stimulation system that incorporates accelerometer technology to automatically adjust stimulation amplitude based on patient position may better meet patient analgesic needs and is in early clinical application.