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MRI with SCS?

jubie1975jjubie1975 Posts: 8
edited 06/11/2012 - 7:56 AM in Spinal Cord Stimulation
Hello everyone,

I've been in an unbelievable amount of pain and have had three CT scans since July. My doc gave me the option to have an MRI even though I have a Spinal Cord Stimulator--he wants to find out what's going on and the CT scans aren't giving him enough information.

The stim battery is located in my upper abdomen area and I have two leads on my spine. Everything I've read states we cannot do this with the stim. My doc said if I start feeling warm to cease with the MRI. I know this is unusual and know my doc wouldn't put me in harms way. I'm wondering if anyone else has gone through this.

Has anyone had an MRI with the stim? If so, did you have any complications?

Thanks for any feedback.

Julie
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Comments

  • I wonder if maybe they can use something to cover up the stim while in the mri? I think i would be a litle worried by dr telling me you can have mri and just let them know its geting hot,


    As long as who ever is doing the mri knows about it they should know if this is ok or not,

    Good luck hope they find what they are looking for and something to help,

    Let us know if they do the mri with scs, I dont remember anyone saying they had it done
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • It used to be that MRI were strictly out if an individual has an implanted SCS. The manufacturers have since come out with very stringent and specific guidelines to follow if it is deemed necessary to have an MRI done. The key lies in the area the SCS is placed versus the area that requires imaging. The biggest problem with an MRI is that it can induce or create heating of the SCS leads. Since the leads are in direct contact with the outer covering of the spinal cord ... well definitely not a place you want any heat building up.

    The best thing to do is speak frankly with your doc and have your company rep there as well. See what they have to say and what they feel the risk versus benefit ratio is.

    It looks by your signature block that you have had several revisions. An MRI can also damage the SCS, which would require yet another revision. Have you considered getting a second opinion on your CT scans. Maybe another doc can see something your current doc can't.

    Welcome to Spine Health

    "C"
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  • I was told never have it with SCS unit. If any thing went wrong with unit it will not be cover. So you be one to pay for it. As for me I don't have $88 ,000 to replace my unit.


    Jim
  • These are the guidelines, precautions and stated risks published for Medtronic SCS systems. This is not an advertisement for Medtronic, it is simply for information in regards to MRI and those with implanted SCS systems. Since I have a Medtronic unit, I have gathered as much information as I could and keep myself apprised of any changes or recalls.

    "C"

    Medtronic said:
    MRI Guidelines
    MRI Guidelines Overview Appendix B


    Medtronic recommends that you do not conduct an MRI examination of any part of the body on a patient using a radio-frequency (RF) transmit body coil. If all of the instructions stated in this Appendix B are followed, MRI examinations of the head only using an RF transmit/receive head coil may be safely performed.

    It is important to read this information in its entirety before conducting an MRI examination on a patient with any implanted component of a Medtronic neurostimulation system for chronic pain. These instructions do not apply to other implantable products or other devices, products, or items. Contact Medtronic at the appropriate address or phone number listed at the back of this document if you have any questions.

    Due to the number and variability of parameters that affect MRI compatibility, the safety of patients or continued functioning of neurostimulation systems exposed to MRI cannot be absolutely ensured. MRI systems generate powerful electromagnetic fields that can produce a number of interactions with implanted components of the neurostimulation system. Some of these interactions, especially heating, are potentially hazardous and can lead to serious injury or death. However, when all instructions stated in this Appendix B are followed, MRI examinations of the head only may be safely performed. In addition, neurostimulation system components can affect the MRI image, potentially impacting the diagnostic use of this modality. The following information describes the potential interactions and control measures that should be taken to minimize the risks from these interactions.

    The instructions in this Appendix B describe how to conduct a head-only MRI examination of a patient with a neurostimulation system implanted for chronic pain, using a transmit/receive head coil of a 1.5-Tesla horizontal bore MRI. MRI examinations of any other part of the body are not recommended, as these require the use of the MRI RF transmit body coil, which may produce hazardous temperatures at the location of the implanted lead electrodes.

    Warnings

    MRI RF transmit body coil – Medtronic recommends that you do not conduct an MRI examination using an RF transmit body coil on a patient with any implanted neurostimulation system component because the interaction of the MRI with the neurostimulation system may lead to serious injury or death. See the section “Risks associated with MRI examination” listed below.

    MRI transmit/receive head coil – An MRI examination of the head only (no other part of the body) can be conducted safely using an RF transmit/receive head coil when all instructions in this Appendix B: MRI and neurostimulation therapy for chronic pain are followed.

    Limitations

    MRI should not be considered for patients with neurostimulation systems if other potentially safer diagnostic methods such as CT, X-ray, ultrasound, or others will provide adequate diagnostic information.
    These instructions apply only to Medtronic neurostimulation therapies for chronic pain for approved indications.
    The instructions in this Appendix B apply to all Medtronic fully implantable neurostimulators, leads, and extensions used for chronic pain therapy.

    Note: The instructions contained in this Appendix B are not applicable to MRI examinations of patients with radiofrequency (RF) neurostimulators.

    Medtronic recommends physicians not prescribe MRI for a patient who has an implanted Itrel 3 Model 7425 Neurostimulator. The Itrel 3 Neurostimulator is highly susceptible to reset or damage when subjected to an MRI examination. If reset, the neurostimulator must be reprogrammed. If damaged, the neurostimulator must be replaced. The Itrel 3 Neurostimulator has an increased risk of induced electrical current, which may stimulate or shock the patient.

    Contact Medtronic at the appropriate telephone number or address listed at the back of this manual for information about newer models or any updates.

    The RF transmit/receive head coil must not cover any implanted system component.
    If the patient has any other implants or products that prohibit or contraindicate an MRI examination, follow the instructions from the manufacturer. The instructions in this Appendix B apply only to the Medtronic products listed above.
    Do not conduct an MRI examination if the patient's neurostimulation system has a broken lead wire, because higher than normal heating may occur at the break or lead electrodes. Excessive heating can cause tissue damage and result in severe injury or death.
    Physicians should not prescribe MRI for patients undergoing trial neurostimulation and having systems that are not fully implanted.
    If the MRI targeted image area is near the neurostimulator, it may be necessary to move the neurostimulator to obtain an image, or use alternate imaging techniques. MRI images may be severely distorted or image target areas can be completely blocked from view near the implanted neurostimulation system components, especially near the neurostimulator.
    Do not remove the neurostimulator and leave the lead system implanted as this can result in higher than expected lead heating. Excessive heating can cause tissue damage and result in severe injury or death.


    Risks

    Risks associated with MRI examination – Exposing a patient with an implanted neurostimulation system or component to MRI may potentially injure the patient or damage the neurostimulator. The known potential risks are as follows:

    Induced electrical currents from the MRI to the neurostimulation system or component may cause heating, especially at the lead-electrode site, resulting in tissue damage. Induced electrical currents may also stimulate or shock the patient.

    Note: This warning applies even if only a lead or extension is implanted.

    Factors that increase the risks of heating and patient injury include, but are not limited to, the following:
    High MRI specific absorption rate (SAR) RF power levels
    Low impedance leads or extensions (Medtronic product names or model numbers designated by a “Z,” an “LZ,” or “low impedance”)
    MRI RF transmit/receive coil that is near or extends over the implanted lead system
    Implanted lead systems with small surface area electrodes
    Short distances between lead electrodes and heat-sensitive tissue
    Exposure to gradients exceeding a dB/dt limit of 20 Tesla per second may result in overstimulation or shocking, particularly for unipolar-capable devices.
    MRI may permanently damage the neurostimulator, requiring explant or replacement.
    MRI may affect the operation of the neurostimulator. The MRI may also reset the parameters to power-on-reset settings, requiring reprogramming with the clinician programmer.
    The Itrel 3 Model 7425 Neurostimulator is highly susceptible to reset or damage when subjected to an MRI examination. If reset, the neurostimulator must be reprogrammed. If damaged, the neurostimulator must be replaced. An Itrel 3 neurostimulator also might exhibit unpredictable behavior if subjected to an MRI examination.
    The neurostimulator may move within the implant pocket and align itself with the MRI field, which may cause patient discomfort or a recent neurostimulator implant incision to open.


    Precautions

    Patient interaction during MRI – If possible, do not sedate the patient so that the patient can provide feedback of any problems during the examination.

    Monitor the patient during the MRI examination. Verify that the patient is feeling normal and is responsive between each individual scan sequence of the MRI examination. Discontinue the MRI immediately if the patient becomes unresponsive to questions or experiences any heating, pain, shocking sensations/uncomfortable stimulation, or unusual sensations.
    Supervision

    MRI procedure using an RF transmit/receive head coil - If all of the instructions stated in this Appendix B are followed, MRI examinations of the head using an RF transmit/receive head coil may be safely performed.

    Prior to the MRI examination, an individual with the proper knowledge of MRI equipment such as an MRI radiologist or MRI physicist must ensure the MRI examination will be conducted according to the information outlined in this Appendix B.

    Note: Due to the additional requirements in these instructions, MRI examination time may be significantly extended.

    MRI exposure requirements

    Prior to an MRI examination, determine whether the patient has multiple active medical device implants (such as deep-brain stimulation systems, implantable cardiac defibrillators, and others). The most restrictive MRI exposure requirements must be used if the patient has multiple active medical device implants. Contact the appropriate manufacturers of the devices if you have questions.

    If the following requirements cannot be met, do not proceed with the MRI examination.

    Use only an RF transmit/receive head coil.*
    Use only a 1.5-Tesla horizontal bore MRI (do not use open-sided or other field strength MRI systems).
    Enter the correct patient weight into the MRI console to ensure the head SAR is estimated correctly.

    The MRI scan sequences must meet the following requirements. If they do not, the pulse parameters must be adjusted so that they comply with these requirements.

    Use MRI examination parameters that limit the head SAR to 1.5 W/kg or less for all RF pulse sequences.
    Limit the gradient dB/dt field to 20 Tesla per second or less.

    *Important: If you are unsure if your MRI has RF transmit/receive head coil capability or if it displays “head SAR”, check with your MRI manufacturer.

    Note: The requirements provided are based on in-vitro testing and should result in a safe MRI examination of a patient with an implanted Medtronic neurostimulation system when all instructions in this Appendix B are followed. However, due to the many variables that affect safety, the safety of patients or continued functionality of neurostimulator systems exposed to MRI cannot be absolutely ensured. The user of this information assumes full responsibility for the consequences of conducting an MRI examination on a patient with an implanted neurostimulation system.
    Preparation for the MRI examination

    Do the following prior to performing an MRI examination on a patient who has an implanted neurostimulation component:

    Inform the patient of all of the risks of undergoing an MRI examination as stated in this Appendix B.
    If possible, do not use sedation so the patient can inform the MRI operator of any heating, discomfort, or other problems.
    Instruct the patient to immediately inform the MRI operator if any discomfort, stimulation, shocking, or heating occurs during the examination.
    Determine if the patient has any other implants or conditions that would prohibit or contraindicate an MRI examination. If you are unclear what implants may be present, perform an X-ray to determine implant type and location. Do not conduct an MRI examination if any conditions or implants that would prohibit or contraindicate an MRI are present.
    Verify that all proposed MRI examination parameters comply with the MRI exposure requirements in this Appendix B. If not, the parameters must be modified to meet these requirements. If parameters cannot be modified, do not perform an MRI.
    If the patient has implanted leads but does not have an implanted neurostimulator, perform the following steps:
    Wrap the external portion of the leads/percutaneous extensions with insulating material, such as dry gauze.
    Keep the external portion of the leads/percutaneous extensions out of contact with the patient.
    Keep the external leads/percutaneous extensions straight, with no loops, and running down the center of the head coil.
    If the patient has an implanted neurostimulator, perform the following steps:
    Review the neurostimulator with a clinician programmer and print out a copy of the programmed parameters for reference.
    Test for possible open circuits by measuring impedance on all electrodes. An impedance measurement greater than 4000Ω for the RestoreULTRA, SynergyPlus+, SynergyCompact+, Synergy Versitrel, Synergy, or Itrel 3 Neurostimulator indicates a possible open circuit. An impedance measurement greater than 3600Ω for the RestoreADVANCED, PrimeADVANCED, RestorePRIME, or Restore Neurostimulator indicates a possible open circuit.
    If an open circuit is suspected, obtain an x-ray to identify whether the open circuit is caused by a broken lead wire. If a broken lead wire is found, do not perform an MRI examination.
    ico2a Warning: Do not conduct an MRI examination if the patient's neurostimulation system has a broken lead wire, because higher than normal heating may occur at the break or lead electrodes. Excessive heating can cause thermal lesions and result in severe injury or death.
    If the system is functioning properly and no broken lead wires are found, program the neurostimulator to the settings provided in the table below.

    Recommended neurostimulator settings for MRI examinations

    Parameter Setting
    Stimulation output OFF (all programs)
    Stimulation mode Bipolar (all programs)
    Amplitude 0 Volts (all programs)
    Magnetic (reed) switch Disabled (Itrel 3 Model 7425 only)
    Other parameters Do not change


    During the MRI examination

    Monitor the patient both visually and audibly. Check the patient between each imaging sequence. Discontinue the MRI examination immediately if the patient is unable to respond to questions or reports any problems.
    Conduct the examination using only the MRI pulse sequence that the MRI radiologist or physicist has confirmed meets the MRI examination requirements in this Appendix B.


    Post-MRI examination review

    Verify that the patient feels normal.
    Verify that the neurostimulator is functional.
    Reprogram the neurostimulator to pre-MRI settings.


  • and welcome to Spine Health.

    As far as I am aware, having a SCS implanted is one of the things that means you can't have an MRI scan done.

    I filled in my form this morning for an MRI scan on Monday and one of the questions asked is if you have an SCS implanted.

    Perhaps you could phone the place where your MRI scan would be done. They would be in a better position to know if it is possible to have one.

    Your doctor and the MRI Centre are the people to advise you here. Between them, they know what equipment will be used and how it is likely to effect a stimulator and the doctor knows what type of stimulator you have fitted and how that may react.

    Do come back and let us know what happens. Then we will all learn something :-)

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  • Thank you all for the quick reply and great information! I'll be sure to ask more questions and if the doc still thinks this is the best course of action, I'll follow-up here on this board. I'm tired of being in pain and would like to be able to live a somewhat normal life again. Hopefully my doc can diagnose me and let me know the best course of action towards feeling better.

    :-)

    May you all have a pain free weekend.

    - Julie
  • Julie, I have a Medtronics SCS and have had a brain MRI after the permanent implant. No complications, but they can only do a brain MRI using the head coil. There is a limit to the amount of magnetic force (gauss).

    Again, I had no problems and felt nothing during the MRI. The only issue I ran into was convincing the imaging staff that it could be done. Medtronics has a toll free number where they will fax information to the imaging department. It is also downloadable from their website

    Jay
  • Thank you Jay for the input! I'm glad you were able to have a successful MRI. :-)

    I spoke with my doc at length today and went over the potential complications with an MRI. He is going to speak with the radiologist about going ahead with my MRI at a lower frequency. He said years ago they would perform MRIs on patients with SCS's until the SCS company stated it could make the batteries faulty. Of course there are potential risks with the leads heating up and damaging the spine or worse.

    I'm afraid I'm going down the route of surgery and want to press forward with the MRI in order to get the best possible picture before the decision of surgery is made (maybe there are other solutions out there other than surgery). In the end, I just want to be in a little less pain than I am today. I've been on bed rest for over a week now and want to go back to work again.

    Thanks for listening....I will keep everyone updated!

    - Julie
  • Hello everyone. I just wanted to provide an update to my original question. My pain doc tried to obtain an MRI for me but the radiologist just wouldn't do it. I didn't argue because of the risk factors. My pain doc has scheduled me for a Myelogram and then I'll get a referral to a neurosurgeon. Thanks to all who took the time to reply. Have a wonderful weekend.

    - Julie
  • of L-spine. No problems. I have C-Spine tomorrow. My leads are in C-spine so...it's suppose to be MRI compatible. Unit is less than a year old, we will see
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