Abstract
A computer model is used to calculate the optimum geometry of an epidural electrode, consisting of a longitudinal contact array, for spinal cord stimulation in the managmment of chronic, intractable pain. 3D models of the spinal area are used for the computation of stimulation induced fields, and a cable model of myelinated nerve fibre is used for the calculation of the threshold stimulus to excite large dorsal column and dorsal root fibres. The criteria for the geometry of the longitudinal contact array are: a low threshold for the stimulation of dorsal column fibres compared with dorsal root fibres; and a low stimulation voltage (and current). For both percutaneous and laminectomy electrodes, the contact length should be approximately 1.5 mm, and the optimum contact separation, as determined by the computer model, is 2–2.5 mm. The contacts for a laminectomy electrode should be approximately 4 mm wide. This electrode geometry is applicable to all spinal levels where the dorsal columns can be stimulated (C1-2 down to L1). The stimulating electrode should preferably be used as a tripole with one (central) cathode.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Barolat, G., Zeme, S. andKetcik, B. (1991): ‘Multifactorial analysis of epidural spinal cord stimulation’,Stereotact. Funct. Neurosurg.,56, pp. 77–103
Barolat, G., Massaro, F., He, J., Zeme, S. andKetcik, B. (1993): ‘Mapping of sensory responses to epidural stimulation of the intraspinal neural structures in man’,J. Neurosurg.,78, pp. 233–239
He, J., Barolat, G., Holsheimer, J. andStruijk, J. J. (1994): ‘Perception threshold and electrode position for spinal cord stimulation’,Pain,59, pp. 55–63
Holsheimer, J. andStruijk, J. J. (1991): ‘How do geometric factors influence epidural spinal cord stimulation? A quantitative analysis by computer modeling’,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. Comput.,33, pp. 676–682
Holsheimer, J. (1997): ‘Effectiveness of spinal cord stimulation in the management of chronic pain: analysis of technical drawbacks and solutions’,Neurosurgery,40, pp. 990–999
Hunter, J.P. andAshby, P. (1994): ‘Segmental effects of epidural spinal cord stimulation in humans’,J. Physiol.,474, pp. 407–419
Jobling, D. T., Tallis, R. C., Sedgwick, E. M. andIllis, L. S. (1980): ‘Electronic aspects of spinal-cord stimulation in multiple sclerosis’,Med. Biol. Eng. Comput.,18, pp. 48–56
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
McNeal, D.R. (1976): ‘Analysis of a model for excitation of myelinated nerve’,IEEE Trans.,BME-23, pp. 329–337
Melzack, R. andWall, P. D. (1965): ‘Pain mechanisms: a new theory’,Sci.,150, pp. 971–979
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
Rattay, F. (1986): ‘Analysis of models for external stimulation of axons’,IEEE Trans.,BME-33, pp. 974–977
Rattay, F. (1987): ‘Ways to approximate current-distance relations for electrically stimulated fibres’,J. Theor. Biol.,125, pp. 339–349
Rijkhoff, N.J.M., Holsheimer, J., Koldewijn, E.L., Struijk, J.J., Van Kerrebroeck, P.E.V., Debruyne, F.M.J., andWijkstra, H. (1994): ‘Selective stimulation of sacral nerve roots for bladder control; a study by computer modeling’,IEEE Trans.,BME-41, pp. 413–424
Robblee, L. S. andRose, T. L. (1990): ‘Electrochemical guidelines for selection of protocols and electrode materials for neural stimulation’, inAgnew, W. F. andMcCreery, D. B., (Eds.): ‘Neural prostheses, fundamental studies’ (Prentice-Hall, Englewood Cliffs) chap. 2, pp. 26–66
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., Barolat, G., He, J., andBoom, H. B. K. (1993a): ‘Paresthesia thresholds in spinal cord stimulation: a comparison of theoretical results with clinical data’,IEEE Trans.,RE-1, pp. 101–108
Struijk, J. J., Holsheimer, J., andBoom, H. B. K. (1993b): ‘Excitation of dorsal root, fibers in spinal cord stimulation: a theoretical study’,IEEE Trans. BME-40, pp. 632–639
Tulgar, M., Barolat, G., andKetcik, B. (1993): ‘Analysis of parameters for epidural spinal cord stimulation. I. Perception and tolerance thresholds resulting from 1,100 combinations’,Stereotact. Funct. Neurosurg.,61, pp. 129–139
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Holsheimer, J., Wesselink, W.A. Optimum electrode geometry for spinal cord stimulation: The narrow bipole and tripole. Med. Biol. Eng. Comput. 35, 493–497 (1997). https://doi.org/10.1007/BF02525529
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02525529