Intraoperative neuromonitoring could be a game changer in the field of SCS by elucidating the MOA for current and emerging SCS waveforms and stimulation patterns. But will it improve outcomes? To find out more, SmartTRAK interviewed Steven Falowski, MD at NANS 2019.Steven Falowski, MD, Secretary of the Board for the North American Neuromodulation Society (NANS), discusses the latest research on the use of intraoperative neuromonitoring during spinal cord stimulation (SCS) in an interview with SmartTRAK at the NANS 22nd annual meeting held Jan. 17-20, 2019 in Las Vegas.
Historically, pain specialists have always placed spinal cord stimulators in awake patients for safety reasons and to confirm the therapy is adequately covering painful areas. However, Dr. Falowski says there’s been a paradigm shift where both pain physicians and surgeons alike are now using intraoperative neuromonitoring to place SCS systems for both percutaneous electrodes and paddle leads in asleep patients to more accurately localize the spinal cord midline and to improve intraoperative electrode placement and pain coverage...
Although much of the research in intraoperative neuromonintoring has been conducted in animals, advances in technology enabled Dr. Falowski to obtain recordings of the human spinal cord and to conduct research on elucidating the potential mechanisms of action of current and emerging SCS waveforms and stimulation paradigms. At NANS, Dr. Falowski presented the results from two human studies evaluating the use of intraoperative neuromonitoring during SCS. One study is a 15-patient observational case series (non-funded) in which electromyography (EMG) and somatosensory evoked potential (SSEP) collision testing was used to analyze traditional tonic stimulation, specific waveform and stimulation platforms, and amplitude differences among SCS devices from MDT, BSX, ABT, and NVRO. The second study is a sub-analysis of the Evoke US pivotal study, in which the Evoke SCS System was used in combination with standard intraoperative neuromonitoring systems during implantation of Evoke patients.
The real question is whether measuring the impact of different waveforms and elucidating these different mechanisms of action will equate into better outcomes. Dr. Falowski says early studies of evoked compound action potentials (ECAP)s suggest that the action potential can be potentially used as a marker of pain relief and three month outcome data from the Evoke study presented at NANS 2019 were promising. Looking to the future, Dr. Falowski believes these data will eventually provide diagnostic information that will allow physicians to better understand what patients are responding to what stimulation paradigm and why.
To find out more about Dr. Falowski’s research and what’s next for intraoperative neuromonitoring, click the following video to listen to SmartTRAK’s full interview with Dr. Falowski. A full transcript of the interview is also provided below.