SCS Paddles vs. Leads

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modelmaker
Regular Member


Date Joined Feb 2009
Total Posts : 168
   Posted 5/4/2009 10:02 AM (GMT -7)   
I'm sorry if this duplicates some other threads but I couldn't locate previous discussions on this topic.

I am considering geting an SCS. The top three in the market appear to be Boston Scientific, Medtronic and St. Jude ANS. Are there others I have missed?

What is the difference between a "paddle" and a "lead" or are they the same thing? If different, when is one used instead of the other?

In looking at the available literature, both Boston and ANS use a constant current system, where Medtronic uses constant voltage. Does anyone know the benefits or disadvantages between these systems?

The Medtronic literature warns against over depletion of the battery (which causes permanent damage). For anyone on this system, how much of a bother is to watch for this an avoid its happening?

As for programming, they all talk about programming during implant surgery. Does the trial use the same programming to truly see if the unit will be as effective as needed? Also, what programs are available to the user after implant surgery? Can the programs be changed by the doc w/o going through surgery again?

It seems that each doctor I have seen or know of has one brand he/she prefers. That begins to sound like a sales rep's pitch working instead of using what will really work best for each unique patient? Am I off base with this? Just an observation. I don't want to have to go through establishing a relationship with three different docs to get the full story on each system.

I would appreciate some help from my CP friends who have personal knowledge of these systems.

Best
Modelmaker

Danimal
Regular Member


Date Joined Mar 2009
Total Posts : 80
   Posted 5/4/2009 12:39 PM (GMT -7)   
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

modelmaker
Regular Member


Date Joined Feb 2009
Total Posts : 168
   Posted 5/4/2009 1:18 PM (GMT -7)   
Hi Danimal,

Thanks for your response.

Within the context of surgical leads, is there a difference between regular leads and paddles? Are all surgical leads called paddles? Are paddles used for some conditions and not others?

Modelmaker

bluejet2
Regular Member


Date Joined Feb 2009
Total Posts : 487
   Posted 5/4/2009 3:19 PM (GMT -7)   
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
Regular Member


Date Joined Mar 2009
Total Posts : 80
   Posted 5/4/2009 6:18 PM (GMT -7)   
I'm pretty sure all surgical leads have a paddle attached to the end of them. That's where the electrodes are. Sometimes they are called paddle leads. Sometimes they are called surgical leads but I believe they are the same thing.

As for whether paddle leads are used for some conditions over others..I don't know! I did get the feeling that surgical leads may be more appropriate for certain patients. It was decided they were more appropriate for me based on the fact that I am young and want to get pregnant (there is a lower risk of lead migration with the surgical lead & paddle..fyi).

modelmaker
Regular Member


Date Joined Feb 2009
Total Posts : 168
   Posted 5/4/2009 7:31 PM (GMT -7)   
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

Danimal
Regular Member


Date Joined Mar 2009
Total Posts : 80
   Posted 5/4/2009 7:44 PM (GMT -7)   
Alan:

My doctor DID indicate that a patient can get better coverage with the surgical leads, simply because the paddle is positioned directly over the nerves. With the percutaneous system, the leads are placed next to the nerves as opposed to being right over the nerves.

Right now, I have 8 programs. I have an A and a B program-group. Each has 4 separate programs. I can run all programs in the B subset at once and likewise with the A (but you can't run the groups together). So...in the B group..I have a program that is for both legs (panty hose efffect), a program that has more stimulation in the left side of my back, one that has more in the right side of my back and then one that seems to stimulate my right leg more (l3-4 pathway). It's difficult to get very specific routes of stimulation without stimulating other parts..so you should be aware of that. In other words..if you only have pain in your legs..it may be difficult to provide stim. for your legs without stimulating parts of your back..simply because the nerves are so close to one another.

My unit has 16 electrodes and with the amplitude options and pulse width options (that means how fast or slow the stimulation comes), there are about half a million programming options, believe it or not!!

BionicWoman
Regular Member


Date Joined Jul 2008
Total Posts : 243
   Posted 5/5/2009 8:58 PM (GMT -7)   
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...... tongue

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.

modelmaker
Regular Member


Date Joined Feb 2009
Total Posts : 168
   Posted 5/5/2009 9:11 PM (GMT -7)   
As a modelmaker I know a little about lithium polymer cells. I don't believe that is the type of cell used in the lithium cells for SCS. But on lithium polymer cells, if you discharge below a critical voltage the cell is permanently damaged and either won't accept a full charge or will rapidly discharge by itself after that incident. Therefore, there are electronic devices programmed to cut off all or portions of the load at the critical voltage to save the cells. I would assume there is something similar to that in the SCS. I just don't know why Medtronic would place a warning on their unit if it is internally protected and difficult to over-discharge in normal use.

Modelmaker

BionicWoman
Regular Member


Date Joined Jul 2008
Total Posts : 243
   Posted 5/6/2009 6:04 PM (GMT -7)   
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? ;-)

SCS#1
New Member


Date Joined May 2009
Total Posts : 5
   Posted 5/11/2009 5:51 PM (GMT -7)   

Hi Modelmaker

I see a lot of misinformation here and want to help you clear a few things up.

Regarding leads-there is a difference. Perc leads are a good non invasive choice and will deliver the same stimulation as a paddle lead if implanted correctly. However Perc leads have a higher risk of migration, which could mean loss of stimulation in some cases. If this happens a lead revision would be done. With Paddle leads they stay in place much better because of the placement and sometimes yield better results because the paddle leads have even spaced contacts between all 16 of them. There is a chance with perc leads the two individual leads would be place too far apart not leading to as precise coverage.

Regarding the battery there is a HUGE difference. MDT battery will REQUIRE surgical intervention..ie a replacement of the battery after 3 over discharge. And it could happen before the 60 days like the other post said. With ANS one overdischarge will affect the battery and could lead to surgical intervention. Its important to know that you lose all programs everytime as well which means more time with the rep, even hours to get the programs you love back. Now to the good part. With Boston Scientific SCS you can deplete it as much as you want (obviously not recommended, but you could be non-compliant) and never lose programs or require a replacement because of the advanced technology. It may seem like not a big deal "I will never do this" however people forget to charge because of vactions, you leave the charger somewhere, illness or pregnancy. Why should you have to deal with worring about a device if you have the choice not too?

As far as programs, the number you get depends on the system you get (MDT, BSCI, ANS) and how good stimulation you get. They can be done at any time without surgical intervention you just call your rep from the company. A good rep will be there everystep of the way.

Doctors use normally what is most cost effective, MDT has been around a long time and can give discounts on products that ANS or BSC cant. However wouldnt you rather your insurance pay a little more for a BETTER product. More and more doctors are catching on that patient outcomes mean the most, if you hava a doc like this then he will use current control device, which tend to feel smoother than voltange base. This leaves ANS and BSC. Now BSC is the only company that can actually steer current by fractionalizing it, other comapnies have an on or off for each electrode. This really only makes one company stand out in my mind..BSC. Do your research and I think you will agree.

Hope this helps.


Stella Marie
Veteran Member


Date Joined May 2005
Total Posts : 601
   Posted 5/11/2009 8:23 PM (GMT -7)   

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.

 

 

 



Stella Marie

Rare neurodegenerative disease called “Multiple System Atrophy”.  Wheelchair, O2, & Bipap, intrathecal pump, neurostimulator, dystonia, neuropathic pain,  spasticity...etc..etc.

Post Edited (Stella Marie) : 5/12/2009 9:39:33 PM (GMT-6)


modelmaker
Regular Member


Date Joined Feb 2009
Total Posts : 168
   Posted 5/12/2009 12:49 PM (GMT -7)   
SCS#1,

I have had 4 previous surgeries including laminectomies and fusions from L-2 to S-1. Would this make it more difficult or less difficult for surgical leads to be implanted? Or does it not matter? With this amount of spinal work done I am not really anxious to go through what amounts to another laminectomy. Would I be better off with just the percutaneous leads?

Modelmaker
Degenerative disc disease, 4 back surgeries, fused from L2-S1, instrumentation. Being treated for chronic pain. Oxycodone 30 mg. IR. Candidate for SCS in the future.


SCS#1
New Member


Date Joined May 2009
Total Posts : 5
   Posted 5/12/2009 7:26 PM (GMT -7)   

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.


modelmaker
Regular Member


Date Joined Feb 2009
Total Posts : 168
   Posted 5/13/2009 7:53 AM (GMT -7)   
Thanks, SCS#1,

Another one for you: My pain is almost all in the back. very little down the legs and only then itermittantly. I would not seek the SCS for the leg pain but I do for back pain. Is the SCS effective in dealing with back-only types of pain?

Alan
Degenerative disc disease, 4 back surgeries, fused from L2-S1, instrumentation. Being treated for chronic pain. Oxycodone 30 mg. IR. Candidate for SCS in the future.

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