Barriers to MRI in patients with spinal cord stimulation: Analysis of a real-world problem with illustrative cases

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Authors: Nestor D Tomycz, Dorian M Kusyk, Justin Davanzo, Branden Ewing, Michael Goldberg, and Michael Spearman
Page Range: 13-22
Published in: Journal of Pain Management, 16#1 (2023)
ISSN: 1939-5914

Table of Contents

ABSTRACT

Technological innovations in spinal cord stimulator (SCS) hardware combined with federal regulatory approval have too often perpetuated a problematic myth that much of current SCS implants are not MR-safe or MR-compatible. The reality is that most modern SCS systems across industry manufacturers are full-body MR conditional, which means that MR imaging can potentially be obtained under certain well prescribed conditions. However, there continues to be a lack of real world data surrounding MR usages in SCS patients. Methods: Utilizing a case series of example patients, this manuscript reviews the technical challenges and nuances involved with MR scanning of patients with SCS implants. We cover the history of SCS implants, the risks posed by MR imaging to patients with these implants, the importance of specific absorption rate (SAR) and how radiologists can modify this parameter to obtain diagnostic images in select patients. Conclusions: Though there is an increasing number of SCS devices labeled as MRI-conditional, this over-simplifies the technical complexities and nuances that accompany obtaining advanced imaging for this patient population. Until these devices can truly become MRI safe through advances in material sciences, we hope that this review fosters a better collaboration between device manufacturers, radiologists and SCS implanting physicians to reduce frustration and improve access for safe MR imaging.

Keywords: Spinal cord stimulator, magnetic resonance imaging, MRI compatibility, failed back syndrome, MRI conditional approval, complications

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