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Professional societies have also published comprehensive guidelines to help guide clinical practice. Table 1 contains a summary of publicly available information regarding MRI conditionality across different device manufacturers. To ameliorate issues between SCS and MRI, a number of SCS manufacturers have developed an MRI-conditional mode. MRI represents a significant potential risk to patients with an implanted spinal cord stimulator, as rotational and spatial gradient forces between the MRI machine and the stimulator can damage tissues and the device itself. Furthermore, we have previously shown that certain populations present special consideration for MRI screening, such as the high-risk breast cancer population, and MRI surveillance and staging, such as aging men (> 50 years old) at risk for prostate cancer or individuals diagnosed with rectal cancers.
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Approximately 82% of patients with spinal cord stimulators (SCS) will need an MRI scan within 5 years after implant. Magnetic resonance imaging (MRI) is a commonly used radiological modality in the diagnosis and surveillance of disease. 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. This case series highlights the need for further investigation of impedance in SCS systems and potential limitations for future MRI usage. 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. All information was obtained via retrospective chart review. Three cases were identified, and informed consent was obtained. High impedance can limit the MRI-conditional mode capability, presenting potential harm to a patient undergoing an MRI or make an MRI unable to be completed. One such limitation is load impedance, referring to the circuit’s resistance to the current being generated by the system. 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. It provides crucial information to the neurosurgeon to prevent postoperative neurological deficits.Magnetic resonance imaging (MRI) conditional modes are a novel feature for certain Food and Drug Administration (FDA)-approved spinal cord stimulation (SCS) devices. Our revised technique is safe and reliable, and it can be easily incorporated into routine intramedullary spinal cord tumor resection. None of the patients had postoperative worsening of the DC function. In 3 cases, negative mapping with the use of this method enabled the surgeon to reliably identify additional inert tissue for incision. DCs were identified in all patients, regardless of whether they could be visually identified. The MR location was neurophysiologically confirmed in all patients in whom this structure was first visually identified as well as in those in whom it was not, with 1 exception. Phase reversal and amplitude changes of somatosensory evoked potentials were used to neurophysiologically identify the laterality of DCs, the inert MR, as well as other safe incision sites. The right and left DCs were stimulated by using a bipolar electric stimulator and the triggered somatosensory evoked potentials recorded from the scalp. To describe a new, safe, and reliable technique for intraoperative DC mapping. We present our experience with and improvements made to our previously described technique of DC mapping, successfully applied in a series of 12 cases. Identification of neurophysiologically viable dorsal columns (DCs) and of neurophysiologically inert tissue, eg, median raphe (MR), as a safe incision site is crucial for avoiding postoperative neurological deficits. Safe resection of intramedullary spinal cord tumors can be challenging, because they often alter the cord anatomy.