The Rate of Magnetic Resonance Imaging in Patients With Spinal Cord Stimulation

Desai, Mehul; Hargens, Liesl; Breitenfeldt, Maria D.; Doth, Alissa H.; Ryan, Michael P.; Gunnarsson, Candace; Safriel, Yair

doi:10.1097/brs.0000000000000805

Cited by 48 publications

(32 citation statements)

References 26 publications

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“…Wireless neural stimulators are being developed to avoid complications associated with traditional lead-based implants (Sahin and Pikov, 2011 ). These complications include lead-breakage, scar-tissue growth, MRI restrictions, and undesirable tethering during animal studies (Hamani and Temel, 2012 ; Desai et al, 2015 ; Ersen et al, 2015 ). The smallest wireless stimulators developed to date are passive in nature and are powered electromagnetically from outside the body.…”

Section: Introductionmentioning

confidence: 99%

A Sub-millimeter, Inductively Powered Neural Stimulator

et al. 2017

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Wireless neural stimulators are being developed to address problems associated with traditional lead-based implants. However, designing wireless stimulators on the sub-millimeter scale (<1 mm3) is challenging. As device size shrinks, it becomes difficult to deliver sufficient wireless power to operate the device. Here, we present a sub-millimeter, inductively powered neural stimulator consisting only of a coil to receive power, a capacitor to tune the resonant frequency of the receiver, and a diode to rectify the radio-frequency signal to produce neural excitation. By replacing any complex receiver circuitry with a simple rectifier, we have reduced the required voltage levels that are needed to operate the device from 0.5 to 1 V (e.g., for CMOS) to ~0.25–0.5 V. This reduced voltage allows the use of smaller receive antennas for power, resulting in a device volume of 0.3–0.5 mm3. The device was encapsulated in epoxy, and successfully passed accelerated lifetime tests in 80°C saline for 2 weeks. We demonstrate a basic proof-of-concept using stimulation with tens of microamps of current delivered to the sciatic nerve in rat to produce a motor response.

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Section: Introductionmentioning

confidence: 99%

A Sub-millimeter, Inductively Powered Neural Stimulator

et al. 2017

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“…The use of diagnostic imaging has substantially increased over the past few decades, with the largest growth in emerging markets [20,21]. It is important that patients receive the most appropriate imaging test for their condition.…”

Section: Discussionmentioning

confidence: 99%

The Rate of Magnetic Resonance Imaging in Patients with Deep Brain Stimulation

Falowski

Safriel

Ryan

et al. 2016

Stereotact Funct Neurosurg

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Background: For Parkinson's disease (PD), essential tremor (ET), and dystonia patients with deep brain stimulation (DBS) implants, magnetic resonance imaging (MRI) requires additional safety considerations due to potentially hazardous interactions. Objective: A propensity-matched cohort of DBS-implanted patients was analyzed to determine the likelihood of needing MRI. Methods: Patients with new DBS full-system implants (n = 576) were identified in the Truven Health MarketScan® Commercial Claims and Medicare Supplemental Databases (2009-2012). Patients diagnosed with PD, ET, or dystonia and no DBS implant were identified (DBS-indicated patients: n = 11,216). The DBS-indicated patients were continuously enrolled for 4 years and matched for age, gender, and propensity score based on comorbid conditions to DBS-implanted patients (n = 4,878 and 543, respectively). A Kaplan-Meier survival curve of time to first MRI was extrapolated to 10 years. Results: An estimated 56-57% of DBS-indicated patients need an MRI within 5 years and 66-75% within 10 years after implantation. While 92% of DBS-implanted patients' MRI after implantation was of the head, for DBS-indicated patients, 62% of MRIs were of the body, potentially unrelated to the primary diagnosis. Conclusions: This analysis highlights the projected utilization of MRI in the DBS population for head and full-body images.

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“…As noted earlier, chronic pain patients have higher than average health care utilization (3). Moreover, calculated rates of expected need for spine MRI in a patient with implanted SCS over the next 5 years is 82% -84% (49). Unfortunately, recommendations on MRI compatibility show the biggest differences between SCS manufacturers and current systems available on the market.…”

Section: Mrimentioning

confidence: 99%

Anesthetic Considerations and Perioperative Management of Spinal Cord Stimulators: Literature Review and Initial Recommendations

et al. 2017

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Background: Patients with implanted spinal cord stimulators (SCS) present to the anesthesia care team for management at many different points along the care continuum. Currently, the literature is sparse on the perioperative management. What is available is confusing; monopolar electrocautery is contraindicated but often used, full body magnetic resonance imaging (MRI) is safe with particular systems but with other manufactures only head and specific extremities exams are safe. Moreover, there are anesthetizing locations outside of the operating room where implanted SCS can interact with surrounding medical equipment and pose significant risk to patient and device. Objectives: The objective of this review is to present relevant known literature about the safe management of SCS in the perioperative period and to begin to develop recommendations. Study Design: A review of current literature and each manufacturers’ labeling was performed to assess risk of interference and patient harm between SCS and technology used in and around typical anesthetizing locations. Methods: A systematic search of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A computerized search was conducted for English articles in print up to April 2016 via PubMed www.ncbi.nlm.nih.gov/pubmed; EMBASE www.embase. com; and Cochrane Library www.thecochranelibrary.com. Search terms included “spinal cord stimulator AND MRI,” “spinal cord stimulator AND ECG,” “spinal cord stimulator AND implanted cardiac device,” “spinal cord stimulator AND electrocautery,” and “spinal cord stimulator AND obstetrics.” In addition, a search of Google and Google Scholar was performed. Websites of SCS manufactures were reviewed. Results: Generalized recommendations include turning the amplitude of the SCS to the lowest possible setting and turning off prior to any procedure. Monopolar electrocautery is contraindicated but is still often utilized; placing grounding pads as far away from the device can reduce the risk to device and patient. Bipolar cautery is favored. Implanted cardiac devices can interfere with SCS, but risks can be minimized. Neuraxial anesthesia can be attempted in a patient with implanted SCS, provided the device is not in the expected path. MRI labeling differences present the biggest difference among SCS manufactures. Medtronic’s SureScan SCS, Boston Scientific’s Precision system, St. Jude’s Proclaim, and Stimwave’s Freedome SCS are full body MRI compatible under specific conditions, while other manufacturers have labeling that restricts exams of the trunk and certain extremities. Limitations: This review was intended to be a comprehensive, cumulative review of recommendations for perioperative SCS management; however, the limitations of a review of this nature is the complete reliance on previously published research and the availability of these studies using the methods outlined. Conclusions: SCS is being used earlier in the treatment algorithm for patients with chronic pain. The anesthesia care team needs working knowledge of where the device resides in the neuraxial space and what risks different medical technologies pose to the patient and device. This understanding will lead to appropriate perioperative management which can reduce risk and improve patient outcomes. Key words: Spinal cord stimulation, perioperative management, MRI, anesthetic considerations, CT scan, interventional pain management

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The Rate of Magnetic Resonance Imaging in Patients With Spinal Cord Stimulation

Cited by 48 publications

References 26 publications

A Sub-millimeter, Inductively Powered Neural Stimulator

A Sub-millimeter, Inductively Powered Neural Stimulator

The Rate of Magnetic Resonance Imaging in Patients with Deep Brain Stimulation

Anesthetic Considerations and Perioperative Management of Spinal Cord Stimulators: Literature Review and Initial Recommendations

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