Summary
The effects of the antero-posterior and medio-lateral positions of the spinal cord in the dural sac on the perception threshold and paresthesia coverage in spinal cord stimulation were analyzed.
The distributions of the dorsal cerebrospinal fluid (CSF) layer thickness, measured from transverse MR scans of normal subjects at various spinal levels, were used to calculate the distributions of threshold voltages for the stimulation of spinal nerve fibers by a computer model. These theoretical threshold distributions were shown to fit well to the corresponding distributions of perception threshold measured in patients.
It is concluded that the thickness of the dorsal csf layer is the main factor determining the perception threshold and paresthesia coverage in spinal cord stimulation: an increasing thickness raises the threshold and reduces the coverage, and vice versa.
The effects of an asymmetrical electrode position with respect to the spinal cord midline were also analyzed by computer modeling. It is concluded that a lateral asymmetry of less than 1 mm gives a significant reduction of perception threshold and may result in unilateral paresthesiae.
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References
Barolat G, Zeme S, Ketcik B (1991) Multifactorial analysis of epidural spinal cord stimulation. Stereotact Funct Neurosurg 56: 77–103
Barolat G, Massaro F, He J, Zeme S, Ketcik B (1993) Mapping of sensory responses to epidural stimulation of the intraspinal neural structures in man. J Neurosurg 78: 233–239
Coburn B (1985) A theoretical study of epidural electrical stimulation of the spinal cord. Part II: effect on long myelinated fibers. IEEE Trans Biomed Eng 32: 978–986
He J, Barolat G, Holsheimer J, Struijk J J (1994) Perception threshold and electrode position for spinal cord stimulation. Pain 59: 55–63
Holsheimer J, Struijk JJ (1991) How do geometric factors influence epidural spinal cord stimulation? A quantitative analysis by computer modeling. Stereotact Funct Neurosurg 56: 234– 249
Holsheimer J, den Boer JA, Struijk JJ, Rozeboom AR (1994) MR assessment of the normal position of the spinal cord in the spinal canal. Am J Neuroradiol 15: 951–959
Holsheimer J, Struijk JJ, Tas NR (1995) Effects of electrode geometry and combination on nerve fibre selectivity in spinal cord stimulation. Med Biol Eng Comp: in press
Jobling DT, Tallis RC, Sedgwick EM, Illis LS (1980) Electronic aspects of spinal-cord stimulation in multiple sclerosis. Med Biol Eng Comp 18: 48–56
Struijk JJ, Holsheimer J, van der Heide GG, Boom HBK (1992) Recruitment of dorsal column fibers in spinal cord stimulation: influence of collateral branching. IEEE Trans Biomed Eng 39: 903–912
Struijk JJ, Holsheimer J, Boom HBK (1993a) Excitation of dorsal root fibers in spinal cord stimulation: a theoretical study. IEEE Trans Biomed Eng 40: 632–639
Struijk JJ, Holsheimer J, Barolat G, He J, Boom HBK (1993b) Paresthesia thresholds in spinal cord stimulation: a comparison of theoretical results with clinical data. IEEE Trans Rehab Eng 1: 101–108
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© 1995 Springer-Verlag
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Holsheimer, J., Barolat, G., Struijk, J.J., He, J. (1995). Significance of the Spinal Cord Position in Spinal Cord Stimulation. In: Meyerson, B.A., Ostertag, C. (eds) Advances in Stereotactic and Functional Neurosurgery 11. Acta Neurochirurgica Supplementum, vol 64. Springer, Vienna. https://doi.org/10.1007/978-3-7091-9419-5_26
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DOI: https://doi.org/10.1007/978-3-7091-9419-5_26
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-9421-8
Online ISBN: 978-3-7091-9419-5
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