Substance Abuse in WV - West Virginia State Medical Association

Special Issue | Scientific Articlestimulation including “vibration inthe area of pain.” He was then giveninformed consent, was educatedregarding the procedure, and wasevaluated for preoperative anesthesiaand sedation. He then underwentan outpatient SCS temporaryimplant. After receiving intravenousvancomycin preoperatively, he wastaken to the operating theatre andplaced in the proper prone positionand prepped and draped in sterilefashion. Fluoroscopic imaging wasused to identify the spine, and theappropriate anatomic landmarks.A laser guided approach wasused to guide the needle to theepidural space to give access forlead placement. The trial leads wereplaced via a minimally invasive,percutaneous approach, into thethoracic spine with a target area ofT8 to T12. These targets were basedon previous mapping which suggeststhese are the spinal regions bestimpacted to produce paresthesia inthe areas of pain. (See figures 1, 2)The leads were left in place for afive day trial period at which timethe resulting paresthesia led to areduction of pain of 70%. The leadswere removed in the office on dayfive. The patient wished to moveforward with the permanent implant.Two weeks after the original trialthe patient underwent reimplantationof the percutaneous leads in thesame target zone as the originalimplant. A cutdown was then createdto the spinal fascia and ligaments.Fatty tissue was debrided and theneedle and stylet were removed. Atthis point, non-absorbable suturewas used to anchor the leads tothe spinal ligaments and fascia. Asubcutaneous pocket was made inthe area just above the beltline, anda tunneling rod was used to tunnelthe leads from the midline incisionto the pocket. The device was thenconnected to the rechargeable batterywith a hex wrench, and computerprogramming was initiated bywireless telemetry. (See s 3, 4, 5)The patient underwent a six weekrecovery period to allow the leads tostabilize and scar into the tissue. Atthis point the patient was placed intoa comprehensive twelve week spinalrehabilitation program with goals ofimproving strength and muscle mass,improving flexibility and regaininghis functional status. At his one yearfollow up he had totally weanedfrom all controlled substances,returned to work as a sky divinginstructor and was matriculatingin an advanced college program.Discussion and LiteratureReviewSpinal cord stimulation is aminimally invasive therapy that3000 Washington St. Westis used for intractable moderate tosevere pain of neuropathic origin.Patients are selected based on failureof reasonable conservative therapies,and the absence of untreatedbleeding disorders, or active systemicinfection. The patient’s outcomeFigure 1.Lead position as viewed under fluoroscopy.Figure 2.Lead placement.SUBSTANCE ABUSE IN WV | Vol. 106 57