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Low Back Paresthesia Coverage in Prone Position is Poor Predictor of Sitting Coverage

Low Back Paresthesia Coverage in Prone Position is Poor Predictor of Sitting Coverage. Katie Rousseau Erich Richter, M.D. LSU Health Sciences Center, New Orleans. Spinal Cord Stimulation. Important treatment for chronic neuropathic back and leg pain

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Low Back Paresthesia Coverage in Prone Position is Poor Predictor of Sitting Coverage

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  1. Low Back Paresthesia Coverage in Prone Position is Poor Predictor of Sitting Coverage Katie Rousseau Erich Richter, M.D. LSU Health Sciences Center, New Orleans

  2. Spinal Cord Stimulation • Important treatment for chronic neuropathic back and leg pain • SCS has traditionally been more effective for the treatment of leg pain than for low back pain1

  3. Current techniques • Clinical efficacy depends on paresthesia coverage of the painful area • There are several techniques for implantation • Awake placement • General anesthesia with fluroscopy • General anesthesia with EMG mapping

  4. Objective • If a patient has low back paresthesia with a specific set of stimulation parameters when prone, how likely are they to still have low back paresthesia with the same stimulation parameters when they are sitting? • Determine the predictive value of prone low back paresthesia for sitting low back paresthesia

  5. Methods • Patients were examined at routine follow up after implantation of permanent paddle lead • A series of programming combinations was tested to determine which combinations gave low back paresthesia coverage while prone • These combinations were then tested in the sitting position to determine if they still gave low back coverage • 8 males, 3 females, ages 44 to 81

  6. Example 1: Prone

  7. Example 1: Sitting

  8. Example 1: Graph Legend: L: left R: right 0: no paresthesia 1: paresthesia present

  9. Example 2: Graph Legend: L: left R: right 0: no paresthesia 1: paresthesia present

  10. Results • Only 58.1% of the settings that generated paresthesia in the low back in the prone position also generated the same coverage while upright • However, successful coverage could be reliably found in all patients when using an electrode with coverage redundancy

  11. Conclusions • Specific electrode combinations producing paresthesia in the low back in the prone position are unreliable at producing the same pattern when sitting • This may have implications for intraoperative physiologic mapping • However, it appears possible to capture the low back with moderate programming changes

  12. Acknowledgements • Funded by Alpha Omega Alpha’s Carolyn L. Kuckein Student Research Fellowship

  13. Questions?

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