Effect of Lead Position and Polarity on Paresthesia Coverage in Spinal Cord Stimulation Therapy: A Computational Study

Neurostimulation in the patient with chronic pain: forecasting the future with data from the present – data-driven analysis or just dreams?

“…However, this localization does not achieve the area of stimulated fibers in maximum DC, which is in all configurations for 5 mm of lateral distance between electrodes. As we showed in our study,14 this result is valid for implants with two parallel leads, with the poles at the same vertebral level (not interspersed as some implanters suggest),68 and with a symmetrical polarity with respect to the midline, with all cathodes on the same lead for each program, a practice described in the literature 69 70. Since from 5 mm of lateral distance the maximum transversal area (mm 2 ) of the DCs within which DC nerve fibers are activated at the stimulation amplitude (area of DC fibers stimulated (ADC)) decreases, and the increase in lateral distance implies a greater preference for stimulation of DR, it can be deduced as a general recommendation never to separate the electrodes more than 5 mm laterally(figure 6).…”

“…Effect of space between implanted leads : With a space of 2 mm between leads a minimum DC/DR ratio is obtained 14. However, this localization does not achieve the area of stimulated fibers in maximum DC, which is in all configurations for 5 mm of lateral distance between electrodes.…”

“…Our group studied, through a model of SCS based on mathematical methods and computational simulation, various configurations of leads, position of these, and programming of polarities, in order to draw conclusions of clinical utility in tonic neurostimulation therapy 11 13 14…”

“…According to Manola et al ,67 the smaller the distance between contacs, the greater the area and depth of the area of fibers stimulated in the DC. According to our model,14 the optimal distance between contacts to maximize the area of stimulated fibers in the DC and their depth is 9 mm. However, it should be borne in mind that, from 4 mm of PD in the lateral position (the most common), the DC/DR ratio increases significantly, facilitating the stimulation of DR compared with that of DC.…”

“…Computational modeling has helped advance the technical aspects of SCS and improve the mechanistic understanding of the therapy and to evaluate the neural activation generated and hence the pain relief achieved,11–14 which today we must implement in our decision making for the management of patients with pain and SCS therapy.…”