Issue link: https://viewer.e-digitaledition.com/i/1464713
Neuromodulation Devices Available at NSPC + Deep brain stimulation + Dorsal root ganglion stimulation + Intrathecal pumps + Motor cortex stimulation + Occipital nerve stimulation + Peripheral nerve stimulation + Spinal cord stimulation + Vagal nerve stimulation INTRATHECAL PUMPS Intrathecal pumps can be used to deliver medications directly to the spinal f luid. Since the medication is delivered straight to the target site, patients may require less medication and may have fewer systemic side effects than they would if they took the medication orally. The intrathecal pump is implanted under the skin at the lower abdomen and attaches to catheters that are directed to the intrathecal space surrounding the appropriate region of the spinal cord. "We use intrathecal pumps to deliver a range of medications," Dr. Snyder says. "They can be deployed to deliver medica- tions including narcotics, local anesthetics, baclofen, which has some adjunctive pain relief, and sometimes other drugs. They can be very effective in some neuropathic pain situations." Intrathecal pumps deliver medications including but not limited to: + Opioids, such as morphine + Non-narcotic pain medications, such as Prialt (ziconotide), a peptide derived from the cone snail that works through inhibition of N-type calcium channels to block nociceptive signals + Skeleta l muscle rela xants, such as baclofen, which may provide some adju- vant pain relief For patients with chronic, debilitating pain that conservative therapies have failed to manage, consultation with a skilled neurosurgeon who is well versed in neuromodulation devices can help ascertain the most beneficial neuromodulation device for that patient. "It's not one-size-fits-all," Dr. Snyder says. "With our experience, we can hope to find the optimal target and the optimal device for the ideal outcome." REVISION SURGERIES Patients with existing implanted neuro- stimulator devices who have not achieved optimal benefit should consider consulta- tion with an NSPC provider for revision surgery. Dr. Snyder successfully performs revision surgeries regularly in addition to initial implantation. An obvious scenario for revision would be a patient presenting with broken neu- romodulation device hardware that was previously beneficial. Dr. Snyder also provides second opinions for patients who are status post neurostim- ulator device placement with continued pain. He can perform surgery for revision of inadequately placed neurostimulators in patients whose existing neurostimulators produce suboptimal results. A more complex issue is whether someone with an existing implanted neuromodulator device should consider revision surgery with a different device. Technology is advancing at a tremendous pace, especially in medicine. This holds true for neuromod- ulation devices, which are rapidly evolving, resulting in more versatile and efficacious treatments. If an improved model has come on the market and the present device isn't meeting the patient's expectations, a newer device may be the appropriate choice. "There are frequently newer models and different studies that are improving the landscape for patients with chronic pain," Dr. Snyder says. "What's happening in the field is very exciting." So, when should patients with relatively outdated neuromodulation devices consider revision surgery? If everything is function- ing well and the patient's pain is optimally controlled, revision surgery is not necessary. However, patients who have previously had a neuromodulation device placed with suboptimal pain control should be referred for a consultation to see whether a newer model or perhaps a different device would An intrathecal pump (as seen here) is another neuromodulating device that ultimately allows medication to be infused into the intrathecal space to reach pain receptors at the target site more efficiently. M D N E W S . C O M /// M D N E W S L O N G I S L A N D ■ 2 0 2 2 0 9