Failure of SCS MR-Conditional Modes Due to High Impedance: A Review of Literature and Case Series
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CASE SERIES
Failure of SCS MR-Conditional Modes Due to High Impedance: A Review of Literature and Case Series Rohan Jotwani . Alaa Abd-Elsayed . Kristine Villegas . Ahmed Shakil . Amitabh Gulati . Dawood Sayed . Christopher Lam . Neel Mehta
Received: September 18, 2020 / Accepted: November 13, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: Magnetic resonance imaging (MRI) conditional modes are a novel feature for certain Food and Drug Administration (FDA)approved spinal cord stimulation (SCS) devices. However, there is a paucity of literature around the limitation of MRI-conditional modes (‘‘MRI safe’’), specifically in clinical scenarios where urgent MRIs may be needed. One such limitation is load impedance, referring to the circuit’s resistance to the current being generated by the system. High impedance can limit the MRIconditional mode capability, presenting
R. Jotwani K. Villegas A. Shakil N. Mehta Anesthesiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA A. Abd-Elsayed (&) Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA e-mail: [email protected] A. Gulati Anesthesia and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA D. Sayed C. Lam Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
potential harm to a patient undergoing an MRI or make an MRI unable to be completed. Methods: Three cases were identified, and informed consent was obtained. All information was obtained via retrospective chart review. Results: In this case series of three patients where MRI-conditional SCS systems were unable to be placed in ‘‘MRI safe’’ settings, preventing timely MRI study completion in the setting of high impedance, all three were required to undergo alternative imaging including CT scans, and two patients ultimately had the system explanted and one chose to be re-implanted after completion of scans. Conclusion: This case series highlights the need for further investigation of impedance in SCS systems and potential limitations for future MRI usage. The review of literature of impedance in SCS shows both device- and physiologic-related etiologies for changes in impedance that warrant consideration by the implanting physician. Keywords: Conditional; Impedance; MRI; SCS
Pain Ther
Key Summary Points Spinal cord stimulator impedances fall within a wide range.
Table 1 MR conditionality across various SCS device manufacturers Company
MR conditions
Nevro
Eligible for full body (1.5 T only) and head and extremity 1.5 T and 3.0 T. 3.0 T requires horizontal cylindrical closed bore MRI systems
Medtronic
No readily available information regarding MRI guidelines
Abbott
Eligible for 1.5 T cylindrical-bore magnet, horizontal field MRI system only
Boston Scientific
Eligible for 1.5 T horizontal closed bore MRI system only
StimWave
No readily available information regarding MRI guidelines
At certain impedances MRI may not be safe. It is important to weigh the risks and benefits when ordering M
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