Illumina 3D & MICC

Question 1

What is something that must be pushed?

Answer 1

Voltage, measured in volts

Question 2

What is “ the number of charge particles flowing over time”?

Answer 2

Current, measured in amperes

Question 3

What is “the opposition to flow, measured in ohms”?

Answer 3

Resistance/impedance

Question 4

What is Ohms law?

Answer 4

V= I x R

Question 5

Explain the constant Voltage system with the water analogy…

Answer 5

If V, or the force/weight/pressure, on the syringe remains the same, then when R (resistance) increases, I (current) will decrease and vice versa.

Question 6

What is the volume of activation?

Answer 6

The volume of the dorsal column that becomes activated through stimulation

Question 7

What does the CSF contain that conducts electricity really well?

Answer 7

Ions

Question 8

Explain the constant current system with the water analogy…

Answer 8

I= V/R… if the current remains the same through the syringe, when the resistance increases, so too must the voltage increase. And if the resistance decreases, so too must the voltage decrease.

Question 9

What happens in a Single Source Constant Voltage system? What is it controlled by?

Answer 9

All contacts remain at the same voltage. If resistance increases for one contact, and voltage is turned up to compensate, then ALL contacts will increase in voltage… resulting in overstimulation, current can move more laterally, and non pain areas can be stimulated.

Impedance controlled therapy

Question 10

Describe the Single Source Constant Current System and what it’s controlled by….

Answer 10

If you have 10amps of constant current, 5 amps will be divided among two contacts (for example). If resistance increases, the current will remain the SAME, so the current will redistribute to the path of least resistance (closest contact with least impedance) and therefore the volume of activation will increase for other contacts. (Overstim,stim in non painful areas, and root stimulation).

Impedance controlled

Question 11

What is different about MICC vs Single source systems?

Answer 11

MICC - each contact has its own source of current, they work independently of each other. When R increases at one contact, nothing happens to the currents of other contacts. The current for the impeded contact will adjust accordingly.
MICC is controlled by percentages!
MICC is clinician controlled system!

Question 12

Describe the hotel analogy for MICC

Answer 12

All rooms use same air conditioner… room 7 gets hot and wants to turn up air.. room 7 is able to turn up air independent of other rooms and other rooms will not change

Question 13

T or F: the field shape for MICC is the smallest compared to single systems

Answer 13

False! It’s the most extensive and wide range

Question 14

What is illumina 3D?

Answer 14

An anatomically guided Neural Targeting ALGORITHM

Question 15

What does the illumina 3D algorithm do?

Answer 15

It automatically calculates optimal configuration based on the input we give! allows us to point and click

Question 16

What are the three inputs we clinicians give Illumina 3D?

Answer 16

Lead location (rostrocaudal, medial lateral, dorsal column) and desired stim field

Question 17

At what percentage did the Lumina study show the illumina 3D algorithm to be more effective than traditional SCS?

Answer 17

~70%

Question 18

What do cathodes do?

Answer 18

Makes the nerve want to fire & CREATES our field

Question 19

What does the Anode do?

Answer 19

Shapes our field

Question 20

T or F: CSF thickness is dependent on vertebral level

Answer 20

True

Question 21

T or F: Focus adjusts the relative distance of anodes from cathodes

Answer 21

True

Question 22

What does focus do so that we may target different fibers?

Answer 22

Changes field shape

Question 23

What happens when the focus is decreased?

Answer 23

Decreases the field> less energy efficient> may feel weaker

*when focus is decreased, the distance between anodes and cathodes decreases

Question 24

What does Pulse width change or do?

Answer 24

It recruits more fibers to be stimulated & it adjusts the duration of each pulse. May be perceived as an increased coverage area…

Question 25

Which IPG’s have Illumina 3D?

Answer 25

All except precision plus

Question 26

What distance do we prefer the leads to be set apart for illumina 3D programming?

Answer 26

2, 4, 6, mm apart - MILLIMETERS!!

Question 27

This, allows the CP user to drag and drop the leads according to anatomical placement, AND, identify and steer the CPS

Answer 27

Flurosync

Question 28

With illumina 3D, which two factors are accounted for that allows the algorithm to make automated amplitude adjustments?

Answer 28

Mediolateral separation and dCSF thickness

Question 29

When managing patient variability, what two things produce a successful outcome in managing dynamic pain?

BLANK + BLANK = successful outcome

Answer 29

Right neural target + Right waveform