gms | German Medical Science

Objective: Epidural spinal cord stimulation (SCS) is an evidence based treatment option for different chronic pain syndromes and in Germany more than 1000 procedures/year are performed. Generally an implanted neurostimulation device is a contraindication for MRI-examinations with only a few specific exemptions under special conditions. On the other hand the indication list for MRI-examinations is growing fast in various medical disciplines. The authors present their clinical experience with new full-body MRI-compatible, CE-approved SCS devices.

Method: Since January 2013 a new generation of leads and stimulation devices with special shielding were implanted. In 12 patients SCS was the first neuromodulatory approach in refractory chronic pain syndromes of various origins. For the test trial the leads were externalized using percutaneous extensions. In case of pain reduction and positive effects the leads were directly connected to the neurostimulator in an abdominal subcutaneous pocket.

Results: In 10 of the 12 patients the test trial was successful and a neurostimulator was implanted. In the remaining two patients the leads were explanted. Because of the fact that no MRI-compatible extensions exist the implanted leads had a length of 90 cm to be connected to the neurostimulator. In 6 of the 10 cases a MRI-scan of the spine, heart and breast was indicated and performed during the postoperative follow-up course. Specific attention must be given to a detailed protocol approved for 1.5 Tesla scanners. Neither technical problems of the neurostimulation devices nor regarding the performance of the MRI or the image quality were reported.

Conclusions: MRI-compatibility remains not longer a problem or obstacle for patients with chronic pain and epidural SCS. MRI-scans with implanted neurostimulation devices at 1.5 Tesla can be performed without complications and good image quality even at the level of the implanted leads at the thoracolumbal spine. Recommendation for the clinical application of MRI-compatible devices as first choice is underlined for all indications of SCS and availability of this novel technical solution.