SCS Paddles vs. Leads

Hi Modelmaker:

I think you probably want to know the difference between surgical leads and percutaneous leads?? All systems use leads. The only system that uses paddles are the surgical LEADS. I have a whole post about this on my blog. Percutaneous leads are put in through a special needle and they remain in the epidural space. Surgical leads are put in through an open incision and a laminotomy vs. a laminectomy and they have a paddle on the end of them where the electrodes reside (as opposed to the electrodes being on the leads themselves).

And each doctor def. has his or her own preference. I asked my doc. why he uses Medtronic and he said he thinks the service is the best and they have the best options for systems. But that is just one opinion!!

Danimal

Hi Modelmaker:

I was told by one surgeon that I consulted for a second opinion that it was his experience that Advanced Bionics SCS worked better for low back pain and Medtronics SCS worked better for leg pain.  The neurosurgeon that has done my surgeries as well as my pain management doctor both use Medtronics equipment exclusively. 

My experience has been that when the surgery is done, a Medtronics rep. will be in the operating room and as the doctor is putting the lead(s) in place, they will be asking you where you are feeling the stimulation and is it "covering" the areas where you have pain.  While you are in recovery immediately following the surgery, they may ask you if you are comfortable with allowing them to turn it on briefly just to make sure that you are still feeling it in the right areas.

Because of swelling caused by the surgery and the post operative development of scar tissue which is what hold the leads in place after the healing process, generally you need at least one more "programming" session to tweak the settings on the SCS to get the best coverage possible to get you maximum pain relief.  Programming is a process of changing the settings of the electrodes (on, off, negative, & positive) and by doing so, different combinations give you stimulation in different areas, and as you did during surgery, you tell them what feels best.

I hope that I have answered some of your questions, and if you have any other questions or concerns, I will be happy to help you to the best of my ability.

Lorie

Danimal,

Did your doc indicate whether the surgical lead was more effective in some kinds of pain than the percutaneous lead or is it just that the surgical is more stable (less migration) and the percutaneous?

How many programs do you have direct access to with your remote? Can you run multiple programs at once?

Alan

I'll chime in on the battery depletion issue, because when I was researching the different systems, I found that it seems to be a bone of a contention and certain literature actually implies it means something it doesn't.

The short answer to how much of a pain it is to keep up with is: it's nothing to even bother worrying about at all and, to my mind, it's absolutely impossible to do it by "accident."

Now, the longer answer to explain that......

Over-discharging the battery does not mean running the system until your battery is dead and the SCS won't turn on. You can run any of the SCS systems until it shuts down from a "dead" battery, as many times as you want, and have no long-term problems. Even when a battery is dead to the point that it won't power whatever device it's in, there's still a few volts of power left in it. Over-discharging the battery happens when the remaining few volts drain from the battery and it hits a true 0 volts.

If you think about it like your car's gas tank - when you get to a certain point, your gas light comes on and tells you that you should get gas. If you ignore it, you'll come to the point that your car is "out of gas" and it can't run anymore. However, if you were to pull your gas tank out of the car and dump it out, you'd find that there's still a little bit of gas in the tank. It's not enough to make the car run, but it's not truly empty either. If you left your car sitting for an extended period of time without putting gas in the not-quite empty tank, that little bit of gas that was left will slowly evaporate and dry up, THEN your tank will be truly empty, dry as a bone.

To over-discharge the battery in the Medtronic systems, you have to run the system until it shuts down and then not recharge it for a minimum of 60 days. For the Eon Mini (ANS), you have to run it until it's dead and then it has a 90-day reserve before the battery is considered over-discharged. Over those 60 or 90 days, the last bits of power in the battery run out until it's really, completely, totally dead. Beyond that point, you'll usually need assistance from your rep to re-power the system, because when it hits a true "dead" battery, the programming will usually get thrown out too.

I'm not sure what ANS recommends as far as replacing the battery if you over-discharge your unit multiple times, but Medtronic recommends replacing the battery if you over-discharge it 3 times. That amounts to leaving the battery sitting dead for a minimum of 60 days, on 3 separate occasions. That's a total of 6 months worth of dead battery and not using your SCS. Of course, they also recommend considering explantation of the system at that point because if a user runs the system dead and leaves it that way for such extended periods of time, then it's highly unlikely they're getting adequate pain relief anyway.

If you have a legitimate reason for not using the SCS for an extended period of time, such as pregnancy or long-term illness, then you just have to make sure the battery is charged when you turn the system off.

They put the warning on the unit because it's a possibility and they're required to disclose the possibility for adverse events. They also put the warnings for epidural hemorrhage, paralysis, seroma, erosion, and allergic response, which all have a less than .5% (one half of one percent) chance of actually happening. CYA in an overly litigious world, y'know? ;-)

I have had the Advanced Bionics system for almost 4 years now.  It features a rechargeable battery.  If you go to each manufacturer's website they will show you actual photographs of each component of their system.  That is also a good place to see the difference between the flat paddle leads and the percutaneous leads. The Metronic system hold 4 programs.  The hand held controller ($1,000 if you lose it - loss not covered by insurance) allows you to select a program and modify the intensity of the signal.  The controller also allows you to turn the system off when not in use.  The manufacturer's rep programs each of the 4 programs to your specific needs.  For example, mine are; feet only - legs and feet - upper thigh area and hips - and finally all.  The rep uses a computer to program the intensity, rate and duration of the signals or impulses. I recharge my system by using a small compact size recharger.  Something similar to double stick tape is applied to the back of the recharger and you stick it to the skin covering the SCS (Spinal Cord Stimulator).  A belt and poach are provided so that you can walk around while it is recharging.  The more you use your system the more often you need to recharge it.  According to the Medtronic rep you can leave the system run dead and no harm will happen.  All you have to do is recharge it and it will be back and operating.  Again, the Medtronic rep told me with normal daily use - the internal battery will last between 7 to 10 years. I decided to have my SCS implanted in my abdomen rather than my hip because I spend time in a wheelchair and in bed.  Other patients have told me the hip location was uncomfortable in wheelchairs. The decision to use paddle leads is a serious one.  Paddle leads must be surgically implanted by a neurosurgeon.  This is a quote from the Mayo clinic pain site:  In SCS, leads are placed in the epidural space near the spinal cord. The leads may be cylindrical or paddle shaped. The advantage of percutaneous leads is that they can be placed with a minimally invasive procedure. The disadvantage is that they may migrate over time and need to be repositioned. Paddle leads in the epidural space are more stable but require a minilaminectomy.      

Model maker

It depends on where you have had your previous surgeries and the resistance in the dural space. They only need to perform a lami in one spot, some patients have 7 or 8 back surgeries. A paddle might be better for you, but your PM will be able to better make that choice.