Preoperative MRI Critical in Identifying Spinal Cord Stimulation Patients

Spinal cord stimulators (SCSs) are employed in managing chronic pain in the cervical, lumbar, and limb areas. They function by placing electrodes in the epidural space near the spinal cord, delivering gentle electrical pulses to the nerves to alleviate pain. Despite their effectiveness, there is a small but significant risk of neurological harm associated with their implantation. To mitigate this risk, medical professionals often utilize preoperative magnetic resonance imaging (MRI) to identify the optimal spots for needle insertion and lead placement and to examine any spinal abnormalities a patient might have. After this imaging step, patients usually undergo a trial with the SCS before deciding on a permanent implant. However, these preoperative MRIs can lead to higher healthcare costs and the need for preauthorization.

Physicians at Pain Diagnostics and Interventional Care (PDIC, Pittsburgh, PA, USA) conducted a study to evaluate the impact of preoperative MRI on modifying treatment plans for cervical and thoracic SCS epidural lead placement. The study involved a retrospective review of patient cases spanning nearly a decade. The findings indicated that MRI indeed had a substantial impact in enough cases, justifying its ongoing use. Out of 343 patients who were evaluated for an SCS trial, 15 (4.4%) required an alteration in the procedure based on MRI results, while 10 patients (3%) were ruled out from proceeding with the SCS trial due to findings on the MRI. The results also showed that MRIs were more effective for patients suffering from cervical pain than those with thoracic or lumbar pain.

The study further revealed that older patients, particularly those aged 60 and above, were more prone to moderate-to-severe cervical and lumbar stenosis, necessitating changes in treatment. This was the first large-scale study examining the role of preprocedural MRIs in influencing the course of SCS percutaneous lead trials. The researchers concluded that, given the broad range of patient characteristics linked to a higher risk of stenosis, all patients should be considered for preprocedural MRI. This approach would help identify spinal pathologies that could potentially modify the progression of SCS percutaneous trials.

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