Effect of Anode-Cathode Configuration on Paresthesia Coverage in Spinal Cord Stimulation

Holsheimer, J.; Wesselink, W.A.

doi:10.1097/00006123-199709000-00030

Cited by 75 publications

(84 citation statements)

References 13 publications

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“…The positioning of the lead in the epidural space is not always easy if one wants to cover the pain region with paresthesias. Leads with different electrode geometry were developed to overcome these problems [17][18][19]. One alternative is the use of more than one lead with multiple electrode contacts.…”

Section: Discussionmentioning

confidence: 99%

Technical Data and Complications of Spinal Cord Stimulation: Data from a Randomized Trial on Critical Limb Ischemia

Spincemaille

Klomp²,

Steyerberg

et al. 2000

Stereotact Funct Neurosurg

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This study was done to evaluate the effect of spinal cord stimulation (SCS) on critical limb ischemia and to report technical problems and complications. One hundred and twenty patients with critical limb ischemia were eligible for randomization between medical treatment and medical treatment plus SCS. Sixty received a spinal cord stimulator (Itrel II; Medtronic, Minneapolis, Minn., USA). Primary outcome measures were limb salvage and pain relief. The mean pain reduction in both treatment groups was 50% (from 5 to 2.5 on the visual analog scale). The 2-year limb survival was 52% (SCS) versus 46% (standard treatment; p = 0.47). The number of patients undergoing major amputations in the SCS group with intermediate TcpO₂ values was half of that in the standard group (14 vs. 28; 24 vs. 48%; p = 0.17). Implantation was successful in 51 patients. Technical problems such as loss of stimulation due to lead displacement occurred in 13 patients (22%), local infection at the site of implantation occurred in 3 patients (5%), resulting in a total complication rate of 27%. Prematue depletion of the battery occurred within 2 years in 3 patients (5%). There were no lead fractures, epidural infections, hematoma or cerebrospinal fluid leakage. Training of physicians and better reliability of the hardware should reduce the frequency of technical problems. Lead displacement remains the major technical problem. The search for prognostic factors of limb salvage is important. One microcirculatory measurement (TcpO₂) seems to have a prognostic value, which remains to be described more precisely.

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Section: Discussionmentioning

confidence: 99%

Technical Data and Complications of Spinal Cord Stimulation: Data from a Randomized Trial on Critical Limb Ischemia

Spincemaille

Klomp²,

Steyerberg

et al. 2000

Stereotact Funct Neurosurg

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“…The computer modeling studies of Holsheimer, Coburn, and Struijk [12][13][14][15][16][17] have shed some light, at least theoretically, on the distribution of the electrical fields within the spinal structures. It is clear that stimulation on the dorsal aspect of the epidural space creates complex electrical fields that affect a large number of structures.…”

Section: Mechanisms Of Actionmentioning

confidence: 99%

Spinal Cord Stimulation: An Update

2008

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Summary:Spinal cord stimulation has been used in the treatment of many chronic pain disorders since 1967. In this update, the indications for spinal cord stimulation are reviewed with attention to recent publications. A focused review of the literature on abdominal and visceral pain syndromes is also provided. Furthermore, the technology has evolved from the use of monopolar electrodes to complex electrode arrays. Similarly, the power source has changed from a radio frequency-driven system to a rechargeable impulse generator. These topics are covered, along with a short discussion of implant technique. Finally, we include a review of complications of such therapy. SCS as a technology and therapy continues to evolve.

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“…35,49,50 In contrast, the preferential stimulation of DC ®bres, resulting in widespread paraesthesia, is favoured by a small CSF layer (lower cervical region) and bipolar or tripolar (central cathode) stimulation with neighbouring contacts centred at the spinal cord midline. These model predictions are con®rmed by a multitude of empirical data.…”

Section: Characteristics Of Clinical Scsmentioning

confidence: 99%

“…Such a change, resulting in the preferential stimulation of DC ®bres, can be obtained by selecting the proper con®guration (uni-, bi-, tripole) and optimizing the electrode geometry. 50,54 The e ects of the size, separation and configuration of a rostro-caudal array of electrode contacts on the thresholds of DC and DR ®bre stimulation have been analyzed systematically by computer modelling. 35 It was concluded that the preferential stimulation of DC ®bres is favoured by tripolar (central cathode) or bipolar stimulation with contacts having small lengths and separations.…”

Section: Characteristics Of Clinical Scsmentioning

confidence: 99%

Computer modelling of spinal cord stimulation and its contribution to therapeutic efficacy

1998

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An overview of computer models developed since the late seventies, which enable the simulation of the primary e ects of spinal cord stimulation (SCS) on nerve ®bres, is presented. These models consist of a 3-dimensional volume conductor model, representing anatomical structures and their electrical conductivities, and cable models representing the electrical behaviour of nerve ®bres. The characteristics of these models and their relation to anatomy and physiology, as well as the calculation of stimulation-induced electrical ®elds and their e ect on nerve ®bre models, are reviewed. It is shown that most characteristics of SCS as predicted by computer modelling correspond well with empirical data. Accordingly, a theoretical framework describing the relations between relevant parameters in SCS is presented. Finally, it is shown how theory and computer modeling are applied to improve the e cacy of SCS by the optimization of its technique, primarily by the design of new epidural electrodes.

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Effect of Anode-Cathode Configuration on Paresthesia Coverage in Spinal Cord Stimulation

Cited by 75 publications

References 13 publications

Technical Data and Complications of Spinal Cord Stimulation: Data from a Randomized Trial on Critical Limb Ischemia

Technical Data and Complications of Spinal Cord Stimulation: Data from a Randomized Trial on Critical Limb Ischemia

Spinal Cord Stimulation: An Update

Computer modelling of spinal cord stimulation and its contribution to therapeutic efficacy

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