Abstract
Percutaneous spinal stimulation is a promising new technique for understanding human spinal reflexes and for evaluating the pathophysiology of motor roots. Previous studies have generally stimulated the T11/T12 or T12/L1 vertebral junctions, sites that overlie the lumbosacral enlargement. The present study sought to determine the best location for targeting sensory and motor roots during sitting. We used paired stimuli, 50 ms apart, to distinguish the contribution of the reflex and motor components which make up the root evoked potential. This assumed that post-stimulation attenuation, primarily through homosynaptic depression, would abolish the second potential if it was trans-synaptic in origin. Conversely, successive responses would be unchanged if motor roots were being stimulated. Here, we show that sensory root reflexes were optimally elicited with percutaneous stimulation over the L1–L3 vertebrae. However, the optimal position varied between subjects and depended on the target muscle being studied. A collision test showed that the reflex recorded in pre-tibial flexors was low in amplitude and was prone to crosstalk from neighbouring muscles. In contrast to the reflex response, direct motor root activation was optimal with stimulation over the more caudal L5–S1 vertebrae. The present results support the utility of paired stimulation for evaluating the topographical recruitment of sensory and motor roots to human leg muscles.
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References
Acosta JA, Raynor EM (2007) Radiculopathy and motor neuron disorders. In: Blum AS, Rutkove SB (eds) The clinical neurophysiology primer. Humana Press, Totowa, p 294
Akaza M, Kanouchi T, Inaba A, Numasawa Y, Irioka T, Mizusawa H, Yokota T (2011) Motor nerve conduction study in cauda equina with high-voltage electrical stimulation in multifocal motor neuropathy and amyotrophic lateral sclerosis. Muscle Nerve 43:274–282
Andriyanova EY (2010) Characteristics of multisegmental monosynaptic responses of leg muscles in subjects with lumber nerve compression. Human Physiol 36:440–446
Courtine G, Harkema SJ, Dy CJ, Gerasimenko YP, Dyhre-Poulsen P (2007) Modulation of multisegmental monosynaptic responses in a variety of leg muscles during walking and running in humans. J Physiol 582:1125–1139
Danner SM, Hofstoetter US, Ladenbauer J, Rattay F, Minassian K (2011) Can the human lumbar posterior columns be stimulated by transcutaneous spinal cord stimulation? A modeling study. Artif Organs 35:257–262
Dy CJ, Gerasimenko YP, Edgerton VR, Dyhre-Poulsen P, Courtine G, Harkema SJ (2010) Phase-dependent modulation of percutaneously elicited multisegmental muscle responses after spinal cord injury. J Neurophysiol 103:2808–2820
Harkema S, Gerasimenko Y, Hodes J, Burdick J, Angeli C, Chen Y, Ferreira C, Willhite A, Rejc E, Grossman RG, Edgerton VR (2011) Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study. Lancet 377:1938–1947
Herman R, He J, D’Luzansky S, Willis W, Dilli S (2002) Spinal cord stimulation facilitates functional walking in a chronic, incomplete spinal cord injured. Spinal Cord 40:65–68
Hofstoetter US, Minassian K, Hofer C, Mayr W, Rattay F, Dimitrijevic MR (2008) Modification of reflex responses to lumbar posterior root stimulation by motor tasks in healthy subjects. Artif Organs 32:644–648
Kagamihara Y, Hayashi A, Okuma Y, Nagaoka M, Nakajima Y, Tanaka R (1998) Reassessment of H-reflex recovery curve using the double stimulation procedure. Muscle Nerve 21:352–360
Kitano K, Koceja DM (2009) Spinal reflex in human lower leg muscles evoked by transcutaneous spinal cord stimulation. J Neurosci Methods 180:111–115
Ladenbauer J, Minassian K, Hofstoetter US, Dimitrijevic MR, Rattay F (2010) Stimulation of the human lumbar spinal cord with implanted and surface electrodes: a computer simulation study. IEEE Trans Neural Syst Rehabil Eng 18:637–645
Maegaki Y, Maeoka Y, Takeshita K (1997) Magnetic stimulation of the lumbosacral vertebral column in children: normal values and possible sites of stimulation. Electroencephalogr Clin Neurophysiol 105:102–108
Maertens de Noordhout A, Rothwell JC, Thompson PD, Day BL, Marsden CD (1988) Percutaneous electrical stimulation of lumbosacral roots in man. J Neurol Neurosurg Psychiatry 51:174–181
Matsumoto H, Octaviana F, Hanajima R, Terao Y, Yugeta A, Hamada M, Inomata-Terada S, Nakatani-Enomoto S, Tsuji S, Ugawa Y (2009) Magnetic lumbosacral motor root stimulation with a flat, large round coil. Clin Neurophysiol 120:770–775
Merton PA, Hill DK, Morton HB, Marsden CD (1982) Scope of a technique for electrical stimulation of human brain, spinal cord, and muscle. Lancet 2:597–600
Minassian K, Jilge B, Rattay F, Pinter MM, Binder H, Gerstenbrand F, Dimitrijevic MR (2004) Stepping-like movements in humans with complete spinal cord injury induced by epidural stimulation of the lumbar cord: electromyographic study of compound muscle action potentials. Spinal Cord 42:401–416
Minassian K, Persy I, Rattay F, Dimitrijevic MR, Hofer C, Kern H (2007) Posterior root-muscle reflexes elicited by transcutaneous stimulation of the human lumbosacral cord. Muscle Nerve 35:327–336
Partanen J, Merikanto J, Kokki H, Kilpelainen R, Koistinen A (2000) Antidromic corticospinal tract potential of the brain. Clin Neurophysiol 111:489–495
Pierrot-Deseilligny E, Burke D (2005) The circuitry of the human spinal cord: its role in motor control and movement disorders. Cambridge University Press, Cambridge, pp 7–8, 16, 96–100
Ranger MR, Irwin GJ, Bunbury KM, Peutrell JM (2008) Changing body position alters the location of the spinal cord within the vertebral canal: a magnetic resonance imaging study. Br J Anaesth 101:804–809
Sabbahi MA, Sengul YS (2010) Thoracolumbar multisegmental motor responses in the upper and lower limbs in healthy subjects. Spinal Cord 49:741–748
Soleiman J, Demaerel P, Rocher S, Maes F, Marchal G (2005) Magnetic resonance imaging study of the level of termination of the conus medullaris and the thecal sac: influence of age and gender. Spine (Phila Pa 1976) 30:1875–1880
Troni W, Bianco C, Coletti Moja M, Dotta M (1996) Improved methodology for lumbosacral nerve root stimulation. Muscle Nerve 19:595–604
Troni W, Di Sapio A, Berra E, Duca S, Merola A, Sperli F, Bertolotto A (2011) A methodological reappraisal of non invasive high voltage electrical stimulation of lumbosacral nerve roots. Clin Neurophysiol 122:2071–2080
Ugawa Y, Rothwell JC, Day BL, Thompson PD, Marsden CD (1989) Magnetic stimulation over the spinal enlargements. J Neurol Neurosurg Psychiatry 52:1025–1032
Acknowledgments
We thank Drs. Monica Gorassini and Jaynie Yang for helpful comments on the manuscript and Dr. Dirk Everaert for assistance in the determination of the spinal levels. Dr. Gorassini kindly loaned equipment for this research which was supported in part by the Canadian Institutes of Health Research.
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Roy, F.D., Gibson, G. & Stein, R.B. Effect of percutaneous stimulation at different spinal levels on the activation of sensory and motor roots. Exp Brain Res 223, 281–289 (2012). https://doi.org/10.1007/s00221-012-3258-6
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DOI: https://doi.org/10.1007/s00221-012-3258-6