SCS Flashcards

Question

Illumina 3d

Answer 1

* model based algorytm (Holsheimer) * CSF thicknes * cerebro caudaal position * mediolateral position

Answer 2

* waveform * CC * MICC * 3D targeting * fieldshaping

Answer 3

* High cervical regions such as C2 can cover regions of the posterior occiput and occasionally the lower jaw. * C2-C4: neck, shoulder, and upper extremities and the lower face as a result of involvement of the descending nucleus of the trigeminal nerve. * C5-C6:entire upper extremity including the hand. * C7-T1 : arms, anterior chest wall, or the axilla. * Occasionally, placement between C4 and T1 may result in coverage of upper and lower extremities, particularly when using current fractionation. * Lateral placement at T11-T12 covers the anterior thigh. * T11-L1 posterior thigh and the foot. * T8-T10 **midline placement** of the electrodes in general seems to provide the best coverage for lower extremity pain. * Low back pain may be difficult to cover because mid-thoracic stimulation can also affect the chest and abdominal wall and stimulation at lower levels preferentially recruits lower extremity fibers; T7-T8 levels are usual targets.

Answer 4

minimal invasive threatment for people suffering from chronic pain

Answer 5

* the IPG produces electrical signals that via the kathodes are delivered to specifiek areas in the spinal cord. these are blocking the pain by blocking the nerves that deliver the painmessage to the brain.

Answer 6

* cochlear implant technology: vb altijd is kortjakje ziek * pacemaker technologie.

Answer 7

* FBSS * CRPS * peripheral neuropathy

Answer 8

* pain management specialist/paincenters * anesthiologists * psychiatrists * neurologists * neurosurggions * ortopedic surgeons * psychiatrist/psychologists

Answer 9

* NSAIDS etc * FT/TENS * Med, behavioral programs * corrective surgery * oral opiods * neurostimulation/intracecal therapy * neuroablation * conservative therapies: * tens/FT etc * additional therapies * prescr/painblock * advanced * neyroablation * pump * SCS

Answer 10

* ligamentum (flavum) holds lamina toether, limits flectie * ligamentum intraspinalis * ligamentum supraspinalis

Answer 11

* myelinated, thicker, faster

Answer 12

management of chron. intractable pain of trunck/and or limbs

Answer 13

* 2004-2005 micc multi indipendant current control * **precicion +** * 2013-2015 illumina 3D * **SPECTRA** * **NOVI** * 2016: Multiwave * 2016: full bodywave MRI * **Montage**

Answer 14

P-botton en centernav for 6sec

Answer 15

Montage Avista MRI perc lead ClickX MRI anchor

Answer 16

* 33cc/11mm *

Answer 17

Right neural target+right waveform= succesfol outcome

Answer 18

illumina 3D trial * multiwave options * prism#D * Burst3D * Whisper (HR)3D

Answer 19

* “gate theory” by Melzack and Wall, whereby electrical stimulation of large myelinated Aβ (A beta) fibers in dorsal columns would result in closing the “gate” and obliterating onward central pain signal transmission from peripheral nociceptors (C fibers) * still not sure

Answer 20

The epidural space is circumferential wrapping around the dura. It is bound by: * The ligamentum flavum posteriorly * The posterior longitudinal ligament and vertebral bodies anteriorly * The vertebral pedicles and intervertebral foramina with their penetrating nerve roots form the lateral borders

Answer 21

In the epidural space. The posterior epidural space, dorsal to the dura, is the target of lead placement for spinal cord stimulation.

Answer 22

Dorsal columns are the target of electrical stimulation. They are formed by large-diameter, heavily myelinated, high conductance sensory fibers (Aβ) The dorsal column’s fibers are somatotopically organized: from medial to lateral: sacral, lumbar, thoracic, and cervical.

Answer 23

The epidural space is circumferential wrapping around the dura and is bound by the ligamentum flavum posteriorly, the posterior longitudinal ligament and vertebral bodies anteriorly. Vertebral pedicles and intervertebral foramina with their penetrating nerve roots form the lateral borders.

Answer 24

Dorsal CSF (dCSF) fluid thickness along the spinal canal is the most important determinant of current spread. dCSF thickness is largest at T4-T8.

Answer 25

the minimum current at which patients perceive paresthesia As current continues to be increased, patients may experience discomfort at higher amplitudes. The minimum current at which patients perceive discomfort is defined as the discomfort threshold (DT). Typical stimulation is carried out between PT and DT.

Answer 26

* depends on the shape of the electrical field and * recruitment of the nerve fibers. Fine tuning of the paresthesia field is achieved by modifying the parameters: 1. frequency, 2. amplitude, 3. pulse width. * Amplitude (A, in mA or milliamperes). Affects the intensity and extent of paresthesiae. Increasing the amplitude expands the area of coverage but could result in uncomfortable stimulation. Typical range: 1.0 to 5 mA. * Pulse width (PW, in μs or microseconds). PW is the duration of single delivered square stimulation pulse. Higher pulse width may help in recruiting smaller nerve fibers in the dorsal column. Pulse width range 20 to 1000 μs. ???? * Frequency (F in Hz or hertz). Frequency is the number of pulses per second. Frequency affects the quality of paresthesia and may be perceived by patients as “smooth” sensation or more of a “thump” sensation. The use of higher amplitudes, higher pulse widths, and higher frequencies would obviously increase the energy consumption and tax recharging frequency.

Answer 27

MDT * prime advanced * restore ultra, restore sensor, restore intellis 13cc * vectris * specify 5-6-5 ABBOT * Proclaim™ Elite Recharge-free SCS System * protege * DRG Axium * penta NEVRO * Senza 35 cc STIMWAVE * freedom NUVECTRA * algovita 4. Nevro Corporation. (2012). Nevro Physician Implant Manual 10186-Eng Rev. F. Menlo Park, CA. 5. Nuvectra. (2014). Algovita™‡ Spinal Cord Stimulation Patient System Manual. Plano, TX. 6. De Ridder, D., Vanneste, S., Plazier, M., & Vancamp, T. (2015). Mimicking the brain: Evaluation of St. Jude Medical’s Prodigy Chronic Pain System with Burst Technology. Expert Review of Medical Devices, 12(2), 143–150. http://dx.doi.org/10.1586/17434440.2015.985652

Answer 28

1. Wipe dry 2. Wipe wet 3. Move 4. Change OR cable 5. Remove lead

Answer 29

1. Take sure IPG is in the pocket (else it show high impedances-not grounded) 2. Connect lead directly to OR cable and measure lead impedance 3. attach extension and meassure again When in Valencia they will try to distract yo by having someone coming in and ask something. While this happens they will do something like taking the IPG out of the pocket or disconnect the lead.

Answer 30

1. impedance test (150-800 Ohms) 2. find CPS You want to be FAST! finetuning is done afterwards * Navigator joystick can be used to move quickly * etroll = 10% steps * Navigator = 3% steps * Manual = 1% step Ask if you can talk with the patient before surgery: explain what you are going to ask. 1. Set up CPS (central point of stimulation) 2. PW=350 us. F= 60 3. increase current to about 4mA to create parasthesia. If you need higher than 8mA to get parasthesia, there is something wrong in the lead system. Ask: What do you feel, Where do you feel it. Increase PW: wider = ? Freq 60-80-100 4. scroll fast with the joistick by holding the button down., to get an impression of the span of the leadplacement 5. After testing switch stimulation OFF (in case lead is moved) Communicate with phycisian: I found the area, do you want to leave the stimulation on? Settings: PW: * you found pain area but to high amplitude * found area, but also ventral root stimulation resolution * fine, medium, coarse Focus: * good coverage, but ventral stimulation or dorsal root stim: first PW, than focus

Answer 31

1. needle entrance level L2 45 degrees 2. proceed to you feel lamina 3. lower to 30 degrees to enter epidural space 4. LOR 5. take out stylet 6. enter lead check AP view: check placement lateral view 7. impedance check + CPR 8. take needle out 9. put on click anchor 10. remove stylet 11. suture to facia 12. click the anchor 13. tunnel

Answer 32

Linear ST (8) 30-50-70 cm * span: 31 cm * spacing: 1 mm (smallest on market) * perc lead * 2 curves stylets (one prealoaded) * straight stylet * 4 suture sleeves * insertian needle with trocar stylet * lead blank * 2 lead positioning labels * stearing cap linear 3-4 * span 52 * spacing 4mm Linear 3-6 * span 66 cm * spacing 6mm Avista MRI (8) 56 -74 cm * span * spacing * perc lead * 2 curves stylets (one prealoaded) * stylet ring with curved and straight stylet * 2 suture sleeves * 4inn insertian needle * stearing cap Infinion CX (16)

Answer 33

KIT * lead extension * hex wrench * tunneling tool 25 cm, 35 cm, 55 cm

Answer 34

Click anchor * 4 cm click anchor * 4 cm click MRI (avista lead) Tunneling tool * 28 + 35 Hex wrench * 4,3 cm, 7,6 cm Insertian needle * 4,5,6 inch

Answer 35

Artisan (16) 50 + 70 cm * 45x8x2 mm CoverEdge (32) 50 + 70 * 50x9x2 mm CoverEdgeX * 67x10x2 mm

Answer 36

Curved _enhanced_ stylet

Answer 37

Platinum Irradium

Answer 38

get - overcome - maintain

Answer 39

lig supraspinalis

Answer 40

THOMSON Randomized controlled doubleblindcrossover study * Optimal sweet spot vary from bottom T8 to top of t 11 * all frequencies alike. * 1khz used 1/3 energy Objection: Senza 50% painreleif * different patient yield, different results * 24mnths not reported * single point VAS collection against realtime e-diary \*3x a day, 3 pain areas) objection 20pt * because studydesign equivalent to more than 100 pt in paralel design study * 3600 datapoints objection: boston sponsored. * 1 person in boston new. He wasn't involved , just adjusting objection wash out * 80% baseline. 2days-2 weeks Medtronic is also using it (high density) they say as long as the density is equivalent to 10K it doesnæ't matter. But they don't have the energysaving advantage

Answer 41

Algoritm based on a 3D anatomic model of the spinal cord, designed to enable more quick and precise targeting Illumina 3D portfolio is designed to customize therapy by delivering multiple waveforms to a precise neural Target 70% sustained painreleiv (lumina study)

Answer 42

Multicenter obeservational study of 213 spectra patients on 13 sites. highly signivicant painreleif was maintained in 24 months. 3D technology has proven to provide 70% better low back painreleiv than our previuous generation system

Answer 43

* more coverage and flexibility * more than just MRI * smallest high capacity cell

Answer 44

1. Focus + Pulswidth 2. change course to fine

SCS Flashcards

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