Implanter's Integrated Information (I3) System: An Aid for Spinal Cord Stimulation Procedures

OBJECTIVES: In spinal cord stimulation (SCS), the electrical stimulation of the spinal cord with an implanted lead evokes a tingling peripheral sensation known as paresthesias. Newer stimulation paradigms allow paresthesia-free treatment, but during the implantation of the lead, paresthesias must cover the painful area to achieve optimal treatment effect. The localization of the evoked paresthesias can be difficult to accurately describe for the patient, and furthermore depends on a complex and only partially predictable set of parameters that includes the anatomical localization and the programming of the electrical field. We aimed to optimize SCS implantation procedures by devising a way to aid the patient in making useful descriptions of the evoked paresthesias, then to visually convey the full set of information-anatomical position of the lead, programming parameters, and evoked paresthesias-directly to the implanting physician.

MATERIALS AND METHODS: To aid the patient in making accurate descriptions of the evoked paresthesia, we use an app dedicated to creating pain drawings on a tablet. We used Chromecast and Apple TV to project the information from the pain drawing tablet and the programming device to two monitors placed in the implanter's field of vision, right next to the fluoroscopy monitor.

RESULTS: The three monitors combined provide a direct visual representation of the dynamic dataset used during SCS implantation: Position, Programming, and Paresthesias, essentially creating the equivalent of the dashboard of a car.

CONCLUSIONS: We present an Implanter's Integrated Information (I3) system; a simple, inexpensive solution for gathering, integrating, and conveying the complex set of information necessary for a successful SCS procedure.