Highest Ranking Oral Abstracts

Despite rapid growth in the utilization of peripheral nerve stimulation (PNS), substantial variability exists in how clinicians evaluate patients, perform procedures, and manage long-term therapy. Many of these practice differences persist because high-quality evidence is limited or conflicting, leaving key aspects of PNS care in a clinical "gray zone." This interactive concurrent panel session will explore unsettled and controversial aspects of PNS practice through a debate-style, pardon-the-interruption format designed to mirror real-world clinical decision-making. Faculty with diverse practice backgrounds will take opposing positions on common but unresolved questions, including the role of diagnostic nerve blocks prior to PNS, whether screening trials are always necessary before permanent implantation, optimal imaging versus landmark-based targeting strategies, the significance of habituation and lead fracture, and whether motor stimulation should be avoided or desired. Additional debates will address whether physical examination maneuvers, imaging findings (such as multifidus atrophy), or adjunctive studies (e.g., EMG) meaningfully predict outcomes; how to manage anticoagulation and antiplatelet therapy around PNS implantation; and what level of training and credentialing is necessary before offering PNS therapy independently. Audience participation will be actively encouraged, with moderators interrupting speakers to highlight conflicting data, challenge assumptions, and solicit real-time polling responses. Rather than promoting a single "correct" approach, this session aims to equip attendees with a nuanced understanding of where consensus exists, where it does not, and how to transparently counsel patients when evidence is incomplete.