Atlas of Implantable Therapies for Pain Management

Atlas of Implantable Therapies for Pain Management This atlas is an essential guide for all implanters, from beginners to the most advanced practitioners. The process of implanting and managing spinal cord stimulators, peripheral nerve stimulators, and intrathecal pumps, from the beginning through long-term management, is thoroughly discussed, as are the prevention and management of complications. Extensive photographs and detailed instructions make each segment a great learning event. The Atlas of Implantable Therapies for Pain Management is a “must-have” resource for any physician wishing to improve his or her skills in interventional pain treatment. ABOUT THE AUTHOR TIMOTHY DEER, MD, is President and Chief Executive Officer of the Center for Pain Relief in Charleston, West Virginia and Clinical Professor of Anesthesiology, West Virginia University School of Medicine, Morgantown. Dr. Deer is the immediate past Chair of the Committee on Pain Medicine for the American Society of Anesthesiologists; a member of the Boards of Directors of the American Academy of Pain Medicine and the American Society of Interventional Pain Physicians; and a member of the Board of Directors and The Executive Board of the International Neuromodulation Society. He is also Chairman of the Scientific Review Committee of the American Academy of Pain Medicine, Chairman of the Scientific Oversight Committee for Pain Medicine of the American Society of Anesthesiologists, and the current President of The West Virginia Society of Interventional Pain Physicians. He lectures widely on the topic of implantable therapies in pain management and is one of the most respected proponents of these therapies worldwide. ISBN-13: 978-0387885667 Atlas of Implantable Therapies for Pain Management 1 Front-matter 2 Atlas of ImplantableTherapies for PainManagement 4 Copyright 5 Foreword 6 Dedications and Acknowledgements 8 Contents 10 Contributors 18 I: Neurostimulation: Spinal Cord Stimulation 21 1: History of Neurostimulation 23 Introduction 23 Neurostimulation First Used in the United States 24 Batteries for Neurostimulation 24 Early Neurostimulation: Advances and Failures 25 High-Frequency Stimulation and Voltage Alterations 25 Modern Neurostimulation: 1960 to the Present 26 Selected Reading 27 2: Spinal Cord Stimulation: Indications and Selection 29 Introduction 29 Patient-Specific Characteristics 30 Disease-Specific Characteristics 31 Suggested Reading 32 3: Needle Placement for Percutaneous Spinal Cord Stimulation of the Back and Legs 33 Introduction 33 Technical Overview 34 Risk Assessment 36 Risk Avoidance 36 Conclusions 37 Selected Reading 37 4: Physician Guided Lead Placement: Making the Lead go to the Target 39 Introduction 39 Technical Overview 40 Risk Assessment 42 Risk Avoidance 42 Conclusions 42 Supplemental Images 42 Suggested Reading 44 5: Anchoring Percutaneous Leads During Permanent Device Placement 45 Introduction 45 Technical Overview 46 Suturing and Anchoring Materials 46 The Deer–Stewart Anchoring Method 46 Risk Assessment 48 Risk Avoidance 48 Conclusions 48 Supplemental Images 48 Suggested Reading 50 6: Tunneling Spinal Cord Stimulation Systems 51 Introduction 51 Technical Overview 52 Risk Assessment 54 Risk Avoidance 55 Conclusions 55 Suggested Reading 55 7: Pocketing Techniques 57 Introduction 57 Technical Overview 57 Risk Assessment 61 Risk Avoidance 61 Conclusions 61 Suggested Reading 62 8: Complications of Spinal Cord Stimulation 63 Introduction 63 Overview of Complications of Spinal Cord Stimulation 64 Complications of the Neuroaxis 64 Complications Outside of the Neuroaxis 66 Complications of the Device 66 Risk Assessment 68 Risk Avoidance 69 Conclusions 71 Supplemental Images 71 Selected Reading 73 9: Programming Spinal Cord Stimulation Systems 75 Introduction 75 Technical Overview 76 Risk Assessment 81 Risk Avoidance 81 Conclusions 82 Selected Reading 82 10: Stimulation of the Spinal Cord by the Placement of Surgical Based Paddle Leads 83 Introduction 84 Technical Overview 84 Risk Assessment 86 Risk Avoidance 87 Conclusions 87 Supplemental Images 87 Suggested Reading 88 II: Neurostimulation: Peripheral Nerve and Peripheral Nerve Field Stimulation 89 11: Stimulation of the Peripheral Nervous System 91 Introduction 91 Selection of Candidates 92 Technical Overview 93 Percutaneous Trialing 93 Percutaneous Permanent Implant 93 Paddle Lead Implantations of the Peripheral Nerve 94 Common Nerve Targets for PNS and PNfS 94 Risk Assessment 97 Risk Avoidance 97 Conclusions 98 Supplemental Images 98 Suggested Reading 100 12: Stimulation of the Nervous System to Treat Neuropathic Pain of the Foot 101 Introduction 101 Technical Overview 102 The Percutaneous Method of Epidural Stimulation 102 The Nerve Root Method of Stimulation 103 Risk Assessment 105 Risk Avoidance 105 Conclusions 106 Supplemental Images 106 Selected Reading 107 13: EMG/SSEP Monitoring During Thoracolumbar Spinal Cord Stimulation 109 General Uses of Neurological Monitoring in Spine Surgery 109 Neurological Testing to Implant Spinal Cord Stimulation Devices 110 Technique of Midline Positioning of the Spinal Cord Stimulator: Tripolar Paddle 111 New Frontiers of Intraoperative EMG Application 111 Conclusions 112 References 112 14: Sacral Nerve Root Stimulation for the Treatment of Pelvic and Rectal Pain 115 Introduction 115 Selection of Candidates 116 Technical Overview 116 Risk Assessment 117 Risk Avoidance 117 Conclusions 118 Supplemental Images 118 Suggested Reading 119 15: EMG/SSEP Monitoring During Sacral Neuromodulation 121 Introduction 121 Technical Overview 122 Technique for Sacral Placement 122 Conclusions 124 References 124 16: Selective Nerve Root Stimulation: Facilitating the Cephalocaudal “Retrograde” Method of Electrode Insertion 127 Introduction 128 Technical Overview 131 Cephalocaudal Lumbosacral Electrode Placement: Foot and Pelvic Root Placement 131 Cephalocaudal Lumbosacral Electrode Placement:Coccygeal Root Placement 132 Cephalocaudal Lumbosacral Electrode Placement: Individual Lower Extremity Root Placement 132 Contraindications 133 Conclusions 133 References 134 III: Neurostimulation: Stimulation of the Cranium and Head 135 17: Stimulation of the Deep Brain for the Treatment of Chronic Pain 137 Introduction 137 Technical Overview 138 Risk Assessment 139 Risk Avoidance 139 Conclusions 140 Suggested Reading 140 18: Stimulation of the Motor Cortex to Treat Chronic Pain 141 Introduction 141 Technical Overview 142 Risk Assessment 145 Risk Avoidance 145 Conclusions 145 Selected Reading 145 19: Stimulation of the Peripheral Nervous System: Occipital Techniques for the Treatment of Occipital Neuritis and Transformed 147 Introduction 148 Technical Overview 148 Risk Assessment 151 Risk Avoidance 151 Conclusions 152 Supplemental Images 152 Suggested Reading 155 IV: Drug Delivery 157 20: History of Intrathecal Drug Delivery 159 Introduction 159 Delivery Systems 160 Suggested Reading 161 21: Selection and Indications for Intrathecal Pump Placement 163 Introduction 163 Factors to Determine Proper Selection for Pump Implantation 164 Factors to Determine Proper Indications for Pump Implantation 164 Conclusions 164 Suggested Reading 165 22: Placement of Intrathecal Needle and Catheter for Chronic Infusion 167 Introduction 167 Technical Overview 168 Risk Assessment 170 Risk Avoidance 170 Conclusions 171 Supplemental Images 171 Suggested Reading 173 23: Securing and Anchoring Permanent Intrathecal Catheters 175 Introduction 175 Technical Overview 176 Suturing and Anchoring Materials 177 The Deer–Stewart Anchoring Method 178 Risk Assessment 178 Risk Avoidance 178 Conclusions 180 Supplemental Images 180 Suggested Reading 182 24: Tunneling Permanent Intrathecal Catheters 183 Introduction 183 Technical Overview 184 Risk Assessment 186 Risk Avoidance 186 Conclusions 187 Supplemental Images 187 Suggested Reading 188 25: Pocketing for Intrathecal Drug Delivery Systems 189 Introduction 189 Technical Overview 189 Risk Assessment 191 Risk Avoidance 191 Conclusions 192 Supplemental Images 192 Suggested Reading 193 26: Drug Selection for Intrathecal Drug Delivery 195 Introduction 195 Technical Overview 196 End of Life 198 Future Research and Development 199 Risk Assessment 199 Risk Avoidance 199 Conclusions 200 Suggested Reading 200 27: Intrathecal Pump Refills 201 Introduction 201 Technical Overview 201 Risk Assessment 202 Risk Avoidance 203 Conclusions 203 Supplemental Images 203 Suggested Reading 206 28: Complications of Intrathecal Drug Delivery 207 Introduction 207 Complications Associated with the Neuroaxis 208 Complications Involving Nonspinal Tissues 208 Complications Involving the Catheter 209 Complications Involving the Implanted Device 209 Complications Involving Administered Agents 210 Treatment of Complications Associated with Implanted Intrathecal Drug Delivery Systems 211 Treatment of Complications Involving the Neuraxis 211 Treatment of Complications Involving Nonspinal Tissues 212 Treatment of Complications Involving the Catheter 212 Treatment of Complications Involving the Implanted Device 212 Treatment of Complications Involving Administered Agents 213 When to Seek Consultation 213 Risk Assessment 213 Risk Avoidance 214 Conclusions 214 Supplemental Images 214 Suggested Reading 216 Index 217 ISBN-10:,0387885668 ISBN-10: 0387885668 Front Matter....Pages i-xvii Front Matter....Pages 1-1 History of Neurostimulation....Pages 3-7 Spinal Cord Stimulation: Indications and Selection....Pages 9-12 Needle Placement for Percutaneous Spinal Cord Stimulation of the Back and Legs....Pages 13-17 Physician Guided Lead Placement: Making the Lead go to the Target....Pages 19-24 Anchoring Percutaneous Leads During Permanent Device Placement....Pages 25-30 Tunneling Spinal Cord Stimulation Systems....Pages 31-35 Pocketing Techniques....Pages 37-42 Complications of Spinal Cord Stimulation....Pages 43-53 Programming Spinal Cord Stimulation Systems....Pages 55-62 Stimulation of the Spinal Cord by the Placement of Surgical Based Paddle Leads....Pages 63-68 Front Matter....Pages 69-69 Stimulation of the Peripheral Nervous System....Pages 71-80 Stimulation of the Nervous System to Treat Neuropathic Pain of the Foot....Pages 81-87 EMG/SSEP Monitoring During Thoracolumbar Spinal Cord Stimulation....Pages 89-94 Sacral Nerve Root Stimulation for the Treatment of Pelvic and Rectal Pain....Pages 95-99 EMG/SSEP Monitoring During Sacral Neuromodulation....Pages 101-105 Selective Nerve Root Stimulation: Facilitating the Cephalocaudal “Retrograde” Method of Electrode Insertion....Pages 107-114 Front Matter....Pages 115-115 Stimulation of the Deep Brain for the Treatment of Chronic Pain....Pages 117-120 Stimulation of the Motor Cortex to Treat Chronic Pain....Pages 121-125 Stimulation of the Peripheral Nervous System: Occipital Techniques for the Treatment of Occipital Neuritis and Transformed Migraine....Pages 127-135 Front Matter....Pages 137-137 History of Intrathecal Drug Delivery....Pages 139-141 Front Matter....Pages 137-137 Selection and Indications for Intrathecal Pump Placement....Pages 143-145 Placement of Intrathecal Needle and Catheter for Chronic Infusion....Pages 147-153 Securing and Anchoring Permanent Intrathecal Catheters....Pages 155-162 Tunneling Permanent Intrathecal Catheters....Pages 163-168 Pocketing for Intrathecal Drug Delivery Systems....Pages 169-173 Drug Selection for Intrathecal Drug Delivery....Pages 175-180 Intrathecal Pump Refills....Pages 181-186 Complications of Intrathecal Drug Delivery....Pages 187-196 Back Matter....Pages 197-201 This Atlas serves as a guide to beginning implanters, intermediate implanters, and the most advanced practitioners. The author covers the process of implanting and managing spinal cord stimulators, peripheral nerve stimulators, and intrathecal pumps from the beginning of the process to long term management. The book also discusses the recognition, prevention, and management of complications. The Atlas is a must for any physician hoping to improve their skills in any segment of this important area of interventional pain treatment. The combination of instructional photographs and detailed instructions makes each segment a great learning event.