Northwestern University Department of Neurosurgery Neurosurgeons and Pain Physicians: Effective Collaboration Joshua M. Rosenow, MD, FAANS, FACS Director, Functional Neurosurgery Associate Professor of Neurosurgery, Neurology and Physical Medicine and Rehabilitation Northwestern Memorial Hospital

Northwestern University Department of Neurosurgery Neurosurgeons and Pain  What do we have to offer?  (besides the capacity to create business for our anesthesia colleagues!)  On basic level – all neurosurgeons are pain surgeons  Spinal surgery  Unique neurosurgical Roles  Paddle leads  Certain peripheral procedures  Craniofacial pain procedures  Central ablative procedures

Northwestern University Department of Neurosurgery Neurosurgical Neurostimulation  Deep brain stimulation  Motor cortex stimulation  Open peripheral nerve stimulation

Northwestern University Department of Neurosurgery Ablative Procedures  Peripheral:  Neurectomy  Ganglionectomy  Rhizotomy  Sympathectomy  Spinal cord  DREZ  Cordotomy  Myelotomy  Brain  Medullary tractotomy  Thalamotomy  Cingulotomy  Hypothalamotomy  Cortical excision  Trigeminal Gangliolysis  RF ablation  Glyercol  Balloon compression

Northwestern University Department of Neurosurgery Neuromodulation Collaboration  Communication pre-implant is important  How did the trial really go?  Best region of stimulation during the trial? Especially important for 16-contact percutaneous lead  What hardware used for trial?  What hardware desired for the implant?  Specific patient factors Social Psychological Physical/Medical Insurance  The referral is invaluable

Northwestern University Department of Neurosurgery Paddle Leads

Northwestern University Department of Neurosurgery Why use paddles?  Previous difficulties with perc leads  Preference of implanter  ?lower current requirement  ?less interference by epidural fat

Northwestern University Department of Neurosurgery Paddle Trial - Unique Neurosurgical Role  Lumbar fusion or laminectomy precluding percutaneous insertion  Inability to access the epidural space percutaneously  Bony anatomy  Obesity  Prior procedure in the region of the implant  Tumor resection, etc.

Northwestern University Department of Neurosurgery Guess the level!

Northwestern University Department of Neurosurgery Communication is key T9 T10

Northwestern University Department of Neurosurgery Collaboration  Works both directions  When I refer:  What do I think is specific diagnosis?  Why am I really referring the patient? Therapeutic procedures Diagnostic procedures Medical management Just don’t know what else to do……  What specific services am I referring for?  Do I expect to get the patient back?  I always leave final discretion to the collaborating physician

Northwestern University Department of Neurosurgery Neurosurgeons and Anesthesiologists  Consultants  Collaborators  Co-conspirators  Our skill sets both overlap and complement each other

Northwestern University Department of Neurosurgery Thank you for coming! Phone:

Northwestern University Department of Neurosurgery