Abstract
A new approach to spinal cord stimulation is presented, by which several serious problems of conventional methods can be solved. A transverse tripolar electrode with a dual-channel voltage stimulator is evaluated theoretically by means of a volume conductor model, combined with nerve fibre models. The simulations predict that a high degree of freedom in the control of activation of dorsal spinal pathways may be obtained with the described system. This implies an easier control of paraesthesia coverage of skin areas and the possibility to correct undesired paraesthesia patterns, caused by lead migration, tissue growth, or anatomical asymmetries, for example, without surgical intervention. It will also be possible to preferentially activate either dorsal column or dorsal root fibres, which has some important clinical advantages. Compared to conventional stimulation systems, the new system has a relatively high current drain.
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References
Bantli, H., Bloedel, J. R., Long, D. M., andThienprasit, P. (1975): ‘Distribution of activity in spinal pathways evoked by experimental dorsal column stimulation,’J. Neurosurg.,42, pp. 290–295
Burton, C. V. (1977): ‘Session on spinal cord stimulation: safety and clinical efficacy,’Neurosurg.,1, pp. 164–165
Barolat, G., Zeme, S., andKetcik, B. (1991): ‘Multifactorial analysis of epidural spinal cord stimulation,’Stereotact. Funct. Neurosurg.,56, pp. 77–103
Coburn, B. (1985): ‘A theoretical study of epidural electrical stimulation of the spinal cord—Part II: Effect on long myelinated fibers,’IEEE Trans.,BME-32, pp. 978–986
Dimitrijevic, M. R., Faganel, J., Sharkey, P. C., andSherwood, A. M. (1980): ‘Study of sensation and muscle twitch responses to spinal cord stimulation,’Int. Rehab. Med.,2, pp. 76–81
Holsheimer, J., Struijk, J. J., andRijkhoff, N. J. M. (1991): ‘Contact combinations in epidural spinal cord stimulation. A comparison by computer modelling,’Stereotact. Funct. Neurosurg.,56, pp. 220–233
Holsheimer, J., andStruijk, J. J. (1991): ‘How do geometric factors influence epidural spinal cord stimulation? A quantitative analysis by computer modelling,’Stereotact. Funct. Neurosurg.,56, pp. 234–249
Holsheimer, J., Den Boer, J. A., Struijk, J. J., andRozeboom, A. R. (1994): ‘MR assessment of the normal position of the spinal cord in the spinal canal,’Am. J. Neuroradiol.,15, pp. 951–959
Holsheimer, J., Struijk, J. J., andTas, N. R. (1995): ‘Effects of electrode geometry and combination on nerve fibre selectivity in spinal cord stimulation,’Med. Biol. Eng. Comp.,33, (5), pp. 676–682
Krainick, J., Thoden, U., andRiechert, T. (1980): ‘Pain reduction in amputees by long-term spinal cord stimulation,’J. Neurosurg.,52, pp. 346–350
Law, J. D. (1983): ‘Spinal stimulation: statistical superiority of monophasic stimulation of narrowly separated longitudinal bipoles having rostral cathodes,’Appl. Neurophysiol.,46, pp. 129–137
Law, J. D. (1986): ‘The ‘failed back syndrome’ treated by percutaneous spinal stimulation’. Proc. 2nd Ann. Meeting American Association of Neurosurgery and College of Neurol. Surg. San Diego, California
Maiman, D. J., Larson, S. J., andSances, Jr. A. (1985): ‘Spinal cord stimulation for pain’ in ‘Neural stimulation 1’ (CRC-Press, Florida) pp. 147–154
McNeal, D. R. (1976): ‘Analysis of a model for excitation of myelinated nerve,’IEEE Trans.,BME-23, pp. 329–337
Nielson, K. D., Adams, J. E., andHosobuchi, Y. (1975): ‘Experience with dorsal column stimulation for relief of chronic intractable pain: 1968–1973,’Surg. Neurol.,4, pp. 148–152
North, R. B., Ewend, M. G., Lawton, M. T., andPiantadosi, S. (1991): ‘Spinal cord stimulation for chronic, intractable pain: superiority of “multi-channel” devices,’Pain,44, pp. 119–130
Sharkey, P. C. (1981): ‘Technological problems of spinal cord stimulation systems: a clinical perspective,’Appl. Neurophysiol.,44, pp. 50–54
Shealy, C. N., Mortimer, J. T., andHagfors, N. R. (1970): ‘Dorsal column electroanalgesia,’J. Neurosurg.,32, pp. 560–564
Sweet, W. H., andWepsig, J. G. (1974): ‘Stimulation of the posterior columns of the spinal cord for pain control: indications, technique and results,’Clin. Neurosurg.,21, pp. 278–310
Struijk, J. J., Holsheimer, J., Van Veen, B. K., andBoom, H. B. K. (1991): ‘Epidural spinal cord stimulation: calculation of field potentials with special reference to dorsal column nerve fibers,’IEEE Trans.,BME-38, pp. 104–110
Struijk, J. J., Holsheimer, J., Van der Heide, G. G., andBoom, H. B. K. (1992): ‘Recruitment of dorsal column fibers in spinal cord stimulation: influence of collateral branching,’IEEE Trans.,BME-39, pp. 903–912
Struijk, J. J., Holsheimer, J., andBoom, H. B. K. (1993a): ‘Excitation of dorsal root fibers in spinal cord stimulation: a theoretical study,’IEEE Trans.,BME-40, pp. 632–639
Struijk, J. J., Holsheimer, J., Barolat, G., He, J., andBoom, H. B. K. (1993b): ‘Paraesthesia thresholds in spinal cord stimulation: a comparison of theoretical results with clinical data,’IEEE Trans.,RE-1, pp. 101–108
Vogel, H. P., Heppner, B., Hümbs, N., Schramm, J., andWagner, C. (1986): ‘Long-term effects of spinal cord stimulation in chronic pain syndromes,’J. Neurol.,233, pp. 16–18
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Struijk, J.J., Holsheimer, J. Transverse tripolar spinal cord stimulation: Theoretical performance of a dual channel system. Med. Biol. Eng. Comput. 34, 273–279 (1996). https://doi.org/10.1007/BF02511237
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DOI: https://doi.org/10.1007/BF02511237