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The Ongoing Debate of the Utility of Magnetic Resonance Imaging Conditional Neuromodulation Devices

There is an ongoing debate regarding the need for magnetic resonance imaging (MRI) conditional devices in neuromodulation. The variable opinions of the community as a whole has been observed in debates by key opinion leaders and presented at major meetings. It is evident that clarity of the issues at hand as well as a balanced approach are necessary to formulate a decision process for our patients. A large focus has been on the decisions of necessity rather than the treating physician’s assessment of patient needs. At this point, it is important for treating physicians to be aware of the different options and varying viewpoints in order to make an educated decision for their patients. Given the increased prevalence of MRI and improving technology, MRI has become a mainstay and first-line imaging choice in many scenarios. The most commonly known to require an MRI are brain/spinal tumors and multiple sclerosis, as well as disorders intrinsic to the neural pathways such as transverse myelitis. This cannot be overshadowed by the advancements in other imaging modalities such as computed tomography (CT) perfusion and CT angiography. The major consideration at hand is that there are many arguments on both sides regarding whether there is a pressing need for MRI in those patients implanted with a spinal cord stimulator. At present, Medtronic, Inc. (Minneapolis, MN, USA) restore spinal cord stimulator (SCS) percutaneous and surgical systems (paddle electrodes) carry an MR conditional label for head scan imaging under specific conditions. Boston Scientific, Inc. (Valencia, CA, USA) has also recently released head scan labeling for a subset of their SCS devices. In addition to head scan labeling, Medtronic has an MR conditional system for full body MRI for a specific subset of their devices. The major difference between the devices for approved head scan imaging vs. full body imaging is that surgical leads are not included in the conditional labeling for full body MRI. Therefore, at present time, access to full body MR conditional imaging is limited to implantation of a SCS with the Medtronic, Inc. Vectris percutaneous lead.