a

Spinal Cord Stimulator Trial

okay so we are going to demonstrate

spinal cord stimulator trial on our

patient here who is a a young not too

young lady who's had severe intractable

low back and leg pain she failed

multiple other treatments and at this

point we are disgusted with her and she

consented to us recording this procedure

and we're going to go ahead with the

spinal cord stimulator trial spinal cord

stimulator as you probably know already

is a device that is placed into the

epidural space and scrambles essentially

scrambles the pain signals as they

travel to the brain they're placed much

in the same way that an epidural

catheter is or an epidural steroid

injection almost we move machine towards

the head a little bit and then angle

towards the seat okay

and it's placed through this the same

epidural needle that we do those

injections and it's the same needle that

you have an epidural for labor and

essentially it's the same premise except

in labor we're putting in this catheter

that allows us to put local anesthetic

into that the dural space where it's

here we're placing a wire that has

electrodes into that space and it is

blocking those transmissions from

getting to the brain what we're doing

now is using the technique to access the

space and as you can see in our video

they're like space for us to access and

that was good we're going to now take

the catheter excuse me the lead call you

can see it here and I don't know if you

can see the on the end there's eight

little metal contacts which are going to

connect to the generator you see that

wire now in the epidural space we move

the Machine stuff a lot we could steer

this up to where we want it to be at

this point you see it's just moving up

there

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and so different parts of the you can

count what we do is we count the ribs

there and you can see there's 12 down

the bottom 11 we're in the middle of 10

we want to get up to the top of the t8

level moving very smoothly here are two

are 12 11 10 9 top of ta so we're going

to place the other one simply come down

doctor where we entered if it's pain is

on one side sometimes you can get away

with just putting in one lead on this

bilateral pain very often we'll place

too and so in this case we are going to

put two and we're going to enter on the

other side here little pinch

toasting local anesthetic for our needle

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and these are lots of resistance syringe

again to access that epidural space and

to pee of the lead

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and we're going to essentially run it

side by side skip my hands out of there

please

so thank you we're going to run it

adjacent to the one that's in place

all right you stop there

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or leads are off in place

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you can see I'm manipulating that little

angle that we have at the top that

allows us to steer it where we want it

to go

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it's really perfect placement there

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so I like the positioning to be

let's get a lateral so we're going to

take a look it's supposed to be in the

posterior epidural space which I'm

pretty confident that that's where we

are and we're going to start testing

momentarily

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brought up

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enough to raise about a little bit

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hold on let's see it should be lucky

okay okay so you can see there clearly

it's in the posterior epidural space

looks good and now we'll come back AP

I'm going to connect during the trial

the there's no incisions that's it for

an implant of this device as a the

generator goes under the skin much in

the same way as the pacemaker does it's

about the same size very similar

technology and for the trial however

this is the extent of what it is as far

as a procedure and that's that generator

what supplies the electrical impulse is

what provides the memory and storage is

all on the outside so we have to connect

these wires which if it was an implant

will go directly into the generator and

then under the skin but in the trial in

the trial we keep that on the outside

and it's one it keeps the cost of the

technology down because if it doesn't

work for the patient then they didn't

have to spend the money on the generator

there's no incisions and you know we

take the leads out which is done is just

in the examination room simply by

cutting the sutures and and pulling it

out

so this adapter is now connected and our

ref is in the back talking to the

patient and making sure that the we're

getting coverage in the appropriate

areas that we want and then what happens

is after the procedure they fine-tune it

and get it get the parameters to the

specificity that is most comfortable for

the patient

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all right we're going to let that happen

now and take a brief pause