Presented at the 2012 AAPM Annual Meeting « Back

Tailored Electrode Configuration and Amplitude in Posture-Adaptive Stimulation: A Case Study

Howard M. Intrater, MD FRCPC, intrater@cc.umanitoba.ca¹, Jackie Cole, RN², Judy Tymkin, RN², Marcia Jarjour, RN³, Donna Schimnowski, RN⁴, Sharon K. Trosky, RN⁵, (1) University of Manitoba, Winnipeg, Manitoba, Canada, (2) Manitoba Association of Registered Nurses, Winnipeg, Manitoba, Canada, (3) Health Sciences Pain Management Centre, Winnipeg, Manitoba, Canada, (4) MARN, Winnipeg, Manitoba, Canada, (5) CRNM, Winnipeg, Manitoba, Canada

Introduction: A common complaint with all conventional spinal cord stimulation systems is the uncomfortable surges associated with position changes. An effective solution for reducing the number of these uncomfortable surges is a position-adaptive stimulation system (recently introduced in Canada), which detects patient position and adjusts therapy accordingly. This case study reports on a patient who required three distinct electrode plus amplitude combinations for three of the postures (lying, upright, and mobile). Materials and Methods: A 63-year-old male, who originally presented with radicular low back and leg pain, had been receiving spinal cord stimulation for 15 years. He frequently complained of posture-related stimulation issues as well as a unique pain pattern while walking. At his most recent device change-out, he received a RestoreSensor™ neurostimulator and a Specify™ 5-6-5 surgical lead (Medtronic, Inc., Minneapolis, MN). During setup of the position-adaptive stimulation feature (AdaptiveStim™), it became apparent that the patient required both position-specific amplitude and electrode configurations. The patient’s device was programmed with the settings noted in Table 1. Results: The patient has achieved excellent functional and quality-of-life improvements (Table 2). He has reduced his need for break through medications, and reports a significantly better quality of life. Conclusions: Spinal cord stimulation patients may need adjustments to amplitude settings and/or to electrode configuration to address their position-related discomfort. The advanced programming capability of the position-adaptive stimulation device provided effective therapy to improve the comfort of this patient.

Funding: None