Advances in Spinal Cord Stimulation

Lam, Christopher M; Latif, Usman; Sack, Andrew; Govindan, Susheel; Sanderson, Miles; Vu, Dan T.; Smith, Gabriella V.; Sayed, Dawood; Khan, Talal W.

doi:10.3390/bioengineering10020185

Cited by 22 publications

(9 citation statements)

References 84 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition to supporting heuristic considerations of SCS mechanisms, the quasi-uniform-mirror modeling has translational implications. As the entire modeling pipeline is linear, it lends itself to closed-form dose optimization (i.e., where a target is specified and an optimal SCS dose predicted; [60] and/or rapid calculations for device programmers or closed-loop applications [61]. These can include targeting specific cell type in the dorsal horn such as islet cells.…”

Section: Discussionmentioning

confidence: 99%

Dorsal horn dendrite polarization during Spinal Cord Stimulation (SCS) predicted using the quasi-uniform-mirror assumption

Zannou,

Koochesfahani,

Russo

et al. 2024

Preprint

View full text Add to dashboard Cite

While the mechanisms of Spinal Cord Stimulation are traditionally assumed to follow pacing of dorsal columns axons, the development of sub-paresthesia SCS and new waveforms has encouraged consideration of different cellular targets. Given their relative proximity to the stimulation electrodes and role in pain processing (e.g., synaptic processing and gate control theory), spinal cord dorsal horn interneurons may be direct targets of stimulation. We developed a novel computational modeling pipeline termed 'quasi-uniform-mirror assumption' and apply it to predict polarization of dorsal horn inter-neuron cell types (Islet type, Central type, Stellate/Radial, Vertical-like) to SCS. The quasi-uniform-mirror assumption allows prediction, for each cell type and location in the dorsal horn, the peak and axis of dendritic polarization as well as the impact of stimulation pulse width. For long pulse (dc), the peak polarization per mA of SCS with a bipolar montage were: Islet type 3.5 mV, Central type 2 mV, Stellate/Radial 1.4 mV, Vertical-like 2.5 mV. For Stellate/Radial the peak dendritic polarization was dorsal-ventral, and for Islet type Central peak dendrite polarization was in the rostral-caudal axis. For Islet type and Central type cells peak dendrite polarization was between stimulation electrodes, while for Stellate/Radial and Vertical-like peak dendrite polarization was under stimulation electrodes. The impact of pulse width depended on cell membrane time constants, which in the quasi-uniform-mirror assumption are uniform first-order. Assuming 1 ms time constant, for a 1 ms or 100 us pulse width, the peak dendrite polarization decreases (from the dc values) by ~33% and ~88%. These results suggest, for the conditions modeled, maximum polarization is of islet-cells in the superficial dorsal horn at locations between electrodes; applying 2 mA 1 ms pulse SCS, the peak islet-cell dendrite polarization is ~4.7 mV. Polarizations of a few mV have been shown to modulate synaptic processing through sub-threshold mechanisms.

show abstract

Section: Discussionmentioning

confidence: 99%

Dorsal horn dendrite polarization during Spinal Cord Stimulation (SCS) predicted using the quasi-uniform-mirror assumption

Zannou,

Koochesfahani,

Russo

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…The interest toward tSCS in the context of SCI is recent and has focused on functional improvements after decades of research mainly dedicated to treating pain (Reviewed in Caylor et al, 2019; Lam et al, 2023; Tapias Perez, 2022). Recent reports in humans suggest that noninvasive tSCS after SCI not only has the potential to improve motor recovery, including walking (Megia Garcia et al, 2020; Seanez and Capogrosso, 2021) and hand function (Inanici et al, 2018; 2021), but also to potentially act as an anti-spastic therapeutic strategy.…”

Section: Discussionmentioning

confidence: 99%

Multi-session transcutaneous spinal cord stimulation prevents chloride homeostasis imbalance and the development of spasticity after spinal cord injury in rat

Malloy,

Côté

2023

Preprint

View full text Add to dashboard Cite

Spasticity is a complex and multidimensional disorder that impacts nearly 75% of individuals with spinal cord injury (SCI) and currently lacks adequate treatment options. This sensorimotor condition is burdensome as hyperexcitability of reflex pathways result in exacerbated reflex responses, co-contractions of antagonistic muscles, and involuntary movements. Transcutaneous spinal cord stimulation (tSCS) has become a popular tool in the human SCI research field. The likeliness for this intervention to be successful as a noninvasive anti-spastic therapy after SCI is suggested by a mild and transitory improvement in spastic symptoms following a single stimulation session, but it remains to be determined if repeated tSCS over the course of weeks can produce more profound effects. Despite its popularity, the neuroplasticity induced by tSCS also remains widely unexplored, particularly due to the lack of suitable animal models to investigate this intervention. Thus, the basis of this work was to use tSCS over multiple sessions (multi-session tSCS) in a rat model to target spasticity after SCI and identify the long-term physiological improvements and anatomical neuroplasticity occurring in the spinal cord. Here, we show that multi-session tSCS in rats with an incomplete (severe T9 contusion) SCI (1) decreases hyperreflexia, (2) increases the low frequency-dependent modulation of the H-reflex, (3) prevents potassium-chloride cotransporter isoform 2 (KCC2) membrane downregulation in lumbar motoneurons, and (4) generally augments motor output, i.e., EMG amplitude in response to single pulses of tSCS, particularly in extensor muscles. Together, this work displays that multi-session tSCS can target and diminish spasticity after SCI as an alternative to pharmacological interventions and begins to highlight the underlying neuroplasticity contributing to its success in improving functional recovery.

show abstract

“…19 While a 3-to 8-day trial period has remained common, the advent of multiple new SCS waveforms has revived discussion on the trial length. 9 In contrast to the instantaneous paresthesiabased programing used in earlier trial types, subperception stimulation has a "wash-in" period between 24 and 72 hours. This has led some to trial with paresthesia-based stimulation or a combination of both paresthesia and subperception threshold stimulations.…”

Section: Evolution Of Trial Usage In Scs Placementmentioning

confidence: 99%

“…Previous publications have eloquently described novel waveforms and closed loop systems. 9,10 In this article, we provide a scoping review on the evolution of operative techniques of SCS and highlight advances most relevant to implanting physicians, specifically the use of trialing, the role of intraoperative neuromonitoring (IONM), and advances in devices and implantation techniques.…”

mentioning

confidence: 99%

The Evolution of Surgical Technique in Spinal Cord Stimulation: A Scoping Review

Bean,

Goon,

McClure

et al. 2023

Operative Neurosurgery

View full text Add to dashboard Cite

Since the advent of spinal cord stimulation (SCS), its operative technique has consistently advanced. We performed a scoping review of the literature regarding SCS operative techniques to highlight key advancements. To review, summarize, and highlight key changes in SCS implantation techniques since their inception. The authors performed a MEDLINE search inclusive of articles from 1967 to June 2023 including human and modeling studies written in English examining the role of trialing, intraoperative neuromonitoring, and surgical adaptations. Using the Rayyan platform, two reviewers performed a blinded title screen. Of the 960 articles, 197 were included in the title screen, 107 were included in the abstract review, and ultimately 69 articles met inclusion criteria. We examined the utility of trialing and found that historical controls showed significant efficacy, whereas recent results are more equivocal. We discuss the significant improvement in outcomes with intraoperative neuromonitoring for asleep SCS placement. We highlight technique improvements that led to significant reductions in infection, lead migration, and inadequate pain relief. Physicians implanting SCS systems for chronic pain management must continually refine their surgical techniques to keep up with this rapidly evolving therapy. In addition, through collaborative efforts of neuromodulators and industry, SCS is safer and more effective for patients suffering from chronic pain.

show abstract

Advances in Spinal Cord Stimulation

Cited by 22 publications

References 84 publications

Dorsal horn dendrite polarization during Spinal Cord Stimulation (SCS) predicted using the quasi-uniform-mirror assumption

Dorsal horn dendrite polarization during Spinal Cord Stimulation (SCS) predicted using the quasi-uniform-mirror assumption

Multi-session transcutaneous spinal cord stimulation prevents chloride homeostasis imbalance and the development of spasticity after spinal cord injury in rat

The Evolution of Surgical Technique in Spinal Cord Stimulation: A Scoping Review

Contact Info

Product

Resources

About