CPT Study Guide Complete Flashcards
1
Q
what is the FDA approval for SCS
A
chronic intractable pain in the trunk and limbs
2
Q
transmit impulses from the central nervous system to the muscles and glands
A
motor/efferent
3
Q
neurons that run from various styles of stimulus receptors to the CNS and carry information such as tough, odor, taste
A
sensory/afferent
4
Q
(most pain) typically acute, pain due to the damage to tissue in response to specific situation
A
nociceptive pain
5
Q
pain that does not develop due to any specific circumstance and is due to nerve damage (burning, shooting, stabbing)
A
neuropathic pain
6
Q
characteristics of chronic pain
A
- diagnosed after 3-6 months
- pain without an apparent cause/physical basis
- spreads in intensity
- no protective function
7
Q
pain conditions typically treated with Neurostim
A
- post laminectomy syndrome (FBSS)
- complex regional pain syndrome (CRPS)
- lumbar radiculopathy
8
Q
what two components make up the central nervous system
A
brain and spinal cord
9
Q
lateral nerve fibers are ___ than medial fibers (middle)
A
larger
10
Q
what role does CSF have on conduction
A
more CSF = higher conductivity, more energy required
11
Q
increased response to stimulus that is normally painful
A
hyperalgesia
12
Q
pain from a stimulus that would not typically cause pain
A
allodynia
13
Q
five parts of a neuron and functions
A
- Soma - brain, signal generated
- Axon - transmits the signal
- Axon terminal
- Dendrites - receive signal
- Axon Hillock - controls firing of AP
14
Q
explain action potential
A
signaling of the neurotransmitters
1. depolarization (sodium influx - flowing in)
2. repolarization (potassium efflux - flowing out)
3. return to resting potential (negative inside, positive outside)
15
Q
low back fibers are more ___ and ___
A
lateral, deeper
16
Q
low back fibers are more _______
A
myelinated (slower response, more challenging to stimulate)
17
Q
where is the CSF the thickest
A
mid/upper thoracic
18
Q
how many segments in the cervical
A
7 (breakfast)
19
Q
how many segments in the thoacic
A
12 (lunch)
20
Q
how many segments in the lumbar
A
5 (dinner)
21
Q
what is a good AP image
A
spinous process midline, pedicles are squared
22
Q
what are the electrodes of a lead made out of
A
platinum iridium
23
Q
dimensions of penta paddle
A
5 columns, 4 rows, 9 mm array, 11 mm width
24
Q
what does it mean to oblique the c-arm
A
adjust the image intensifier closer or further from the physician
25
directed towards the head or anterior (term)
cephalad
26
directed towards the tail or posterior (term)
caudal
27
implant depth of proclaim
4 cm
28
implant depth of eterna
2.5 cm
29
what range of pulse width is supported by proclaim IPGs
20-1,000 ms
30
which mode of stimulation is approved for our FDA DPN indication
tonic
31
how many areas can be programmed during a TRIAL for proclaim plus (flexburst)
4
32
how many areas can be programmed during a PERM for proclaim plus (flexburst)
6
33
what should be avoided by patients during the trial
BLTs - bending, lifting, twisting
33
what do you tell patients is the battery life for eterna
"up to 10 years" depending on energy usage
34
needle angle for epidural space at T12-L1
30 degrees
35
(SCS lead placement) back pain
T7-T8, or T8-T9
36
(SCS lead placement) back and leg pain
T8-T9
37
(SCS lead placement) leg pain
T9-T10, or T10-T11
38
(SCS lead placement) foot pain
T10-T11, or T11-T12
39
when intraop testing, which lead should be placed on the LEFT of the MLTC
1-8
40
describe prepping the IPG with the scrub tech before inserting the leads
2 full rotations of screws using wrench in kit. keep on the back table until needed
41
(procedure) removing the entire lamina (back of vertebrae)
laminectomy
42
(procedure) removing a small portion of the lamina
laminotomy
43
(procedure) removing one side of lamina
hemilaminectomy
44
what level is the laminectomy performed for paddle placement (Ex: if the MD is targeting T8 for low back pain)
one level below (T9)
45
explain the tunneling process
from spine to pocket, tunneling through the skin then feeding the lead through
46
what levels would the physician typically enter for a cervical SCS TRIAL
C7-T1 or T2-T3
47
explain the epidural needle placement/access
entering skin 1.5-2 pedicles below target interlaminar space with a paramedian approach (slightly lateral to midline)
48
what inch needle comes in SCS kit?
4 in straight
49
what are the characteristics of BurstDR waveform
* silent waveform/therapy
* low programming burden
* affects lateral + medial pathways
50
how many pulses are in a BurstDR pulse train
5
51
(pathway) that targets the psychological response to pain
medial
52
(pathway) that targets the physical response to pain
lateral
53
how many patients were enrolled in the SUNBURST study
173
54
how many patients were randomized in the SUNBURST study
100
55
primary endpoint/goal of SUNBURST study
that the new BurstDR treatment is not significantly worse than traditional SCS, and that it may be superior when comparing mean VAS scores
56
SUNBURST - what % of patients preferred BurstDR over traditional tonic SCS
70.8%
57
stands for virtual analog scale, measures pain intensity
VAS
58
where does the 1-8 lead go in the MLTC
left lead, closer to the CORD
59
what are the three BOLD dosing protocol programs given to ALL newly implanted patients
30/130
30/2
30/6
60
what are the results from the BOLD clinical study
BurstDR reduced negative physiological effects associated with chronic pain (medial pathway)
61
what are the key takeaways from the BOLDER study
low energy BurstDR stimulation is superior to tonic, data supporting 30/6 program
62
pulse width is measured in
microseconds (us)
63
frequency is measured in
hertz (Hz)
64
amplitude is measured in
milliamps (mA)
65
what is the maximum target amplitude you should set BurstDR
1.5
66
what is the proper cycling or dosing times when using Flexburst360
2 min/12 min
2 min/6 min
67
how many contacts on the penta lead are independent
12
68
what are some key features of eterna SCS IPG
* smallest rechargeable
* full body MRI compatible
* lowest recharge burden
69
in a chronic pain state, the DRG firing threshold is ___ and thus the DRG is ____
lower, hyperexcitable
70
the T junction acts as
* barrier to propagation of AP
* low pass filter
* processing point for pain signals
* participant in propagation of AP
71
where is the DRG located
in the superior aspect of the neural foramen, just under the pedicle
72
(DRG) the lead passes through ___ to access the DRG in the neural foramen
intraforaminal ligaments
73
the DRG is the largest at which level
L5
74
what was the indication studied in the DRG ACCURATE study?
chronic intractable pain of the lower limbs ONLY
75
How many patients were enrolled in the DRG ACCURATE study
152
76
(DRG ACCURATE) what percentage of the implant group reached the primary end point at three months
93.3%
77
(DRG ACCURATE) at 12 months ___% of the implant only DRG stimulation group achieved the primary endpoint for pain relief vs ___% of the control (SCS)
86% DRG
70% control (SCS)
78
(DRG ACCURATE) what % of patients were considered high responders (>80% VAS score) at 3 months
70%
79
what is the FDA indication for DRG
CRPS 1 and 2 (causalgia)
80
what is the different between CRPS 1 and 2
CRPS 1 has an unknown cause (the nerve is not identifiable), where CRPS 2 has a known cause (known damaged nerve)
81
(DRG lead placement) foot pain
L4-L5-S1
82
(DRG lead placement) knee pain
L3-L4
83
(DRG lead placement) groin pain
T12-L2
84
(DRG lead placement) pelvic foot pain
L1
85
when would you use DRG vs. SCS
SCS - damage to the central nervous system (right foot pain following back surgery)
DRG - damage to the limbs (neuropathic pain to the right foot following an ankle sprain)
86
the axium (DRG) lead has ___ electrodes
4
87
what does the black marker on the needle of the axium (DRG) indicate
the direction of the bevel
88
what length axium (DRG) system needles are available for DRG
4.5 and 6 inch (standard is 4)
89
what are the two delivery sheath sizes for the axium (DRG) system
8 mm and 2 mm (8 mm is more commonly used, 2 mm comes in kit)
90
can a torque wrench included in the SCS system be used with the DRG system? are they interchangeable
NO
91
for DRG, what interlaminar space are you entering in relation to the target pedicle
enter superiorly and midline in the interlaminar space 1 vertebral body below the target pedicle
92
for DRG, what skin entry are you entering in relation to the target pedicle
enter contralaterally 2-3 pedicles below the target pedicle
93
L4 and L5 needle trajectory tends to be ___ and more ___ than T10-L3
contralateral, wider
94
(DRG) epidural entry at L5 is typically ___ to midline on the ___ side
lateral, contralateral
95
(DRG) typically electrodes __ and __ should be under the target pedicle
2 and 3
96
what is the removal process for the delivery system (DRG)
sheath, needle, stylet
97
what are the recommended programming parameters for DRG pulse width and frequency
20 Hz frequency, 200 pulse width
98
what are the three DRG products that contain a DRG torque wrench
1. tunneling tool
2. IPG / battery
3. extensions
99
how many leads can the DRG EPG* header accommodate
2
100
how many leads can the DRG IPG* accommodate
4
101
what levels is the proclaim DRG system FDA approved for, and also MRI conditional at
T10-S2
