Got a referral from neurosurgeon on a pt with cervical radiculopathy s/p ACDF 7 years ago. She's got a St. Jude SCS in place 3 years prior. Recently reprogrammed a month ago by rep. 70% coverage/relief but states she can't use it all the time because stim changes w head movement. Gets relief when she is able to use it though. Was told by neurosurgeon that we could do an epidural for her. Told her I wouldn't do an epidural since she has an SCS in place. She was told that by 2 other pain physicians but decided to come to us anyway since the neurosurgeon is in my group and told her it could be done. Was upset when I told her I wouldn't do it. Don't think I can work magic around the leads that are in her epidural space. The other pain physician she saw did diagnostic MBBs which helped her axial neck pain and offered RF for her, and she was upset he couldn't do the RF the same day she did the MBBs if they helped. I explained the difference between diagnostic and therapeutic procedures for her. She still was upset that she was told by the neurosurgeon I would perform magic. Thoughts? LOL.
ESI with SCS
- Thread starter gasgasgas
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i would be careful doing RF in a patient with a SCS. suggest contacting SCS rep first. regarding epidural - could try a TF CESI.
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Unreasonable expectations still. No soup for her.
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Exactly. This patient will never be happy, and isnt respectful of you. Find a way to punt.
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$10 says she never returns...
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Yep. Fold your cards and try to win next round.
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Highly unlikely to not remotely possible.
I just figured that if she has an SCS for upper extremity neuropathy, it should theoretically cover her pain... which it does. as I said, 70% relief, only she complains that it varies with head positioning and she doesn't want to have it all the time. Common sense tells me that if it helps with her pain, she gets good relief with it, why not use it? The other part of it is that if I'm going to do an injection of steroids near where the leads are, it just seems not that safe. And, moreover, I don't do cervical TFESIs, so that's a moot point (for me). Correct me if I am wrong, I can always use some more learning/education on this if this comes up again. If this was lumbar SCS, I may be more willing to do it, but still, I would think if you have a device in place that works, why not use that?
