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Staggered Transverse Tripoles With Quadripolar Lateral Anodes Using Percutaneous and Surgical Leads in Spinal Cord Stimulation

Sankarasubramanian, Vishwanath MSc; Buitenweg, Jan R. PhD; Holsheimer, Jan PhD; Veltink, Peter H. PhD

Neurosurgery:
doi: 10.1227/NEU.0b013e31827d0e12
Concepts, Innovations, and Techniques
Abstract

BACKGROUND: In spinal cord stimulation for low-back pain, the use of electrode arrays with both low-power requirements and selective activation of target dorsal column (DC) fibers is desired. The aligned transverse tripolar lead configuration offers the best DC selectivity. Electrode alignment of the same configuration using 3 parallel percutaneous leads is possible, but compromised by longitudinal migration, resulting in loss of DC selectivity. This loss might be repaired by using the adjacent anodal contacts on the lateral leads.

OBJECTIVE: To investigate if stimulation using adjacent anodal contacts on the lateral percutaneous leads of a staggered transverse tripole can restore DC selectivity.

METHODS: Staggered transverse tripoles with quadripolar lateral anodes were modeled on the low-thoracic vertebral region (T10–T12) of the spinal cord using (a) percutaneous lead with staggered quadripolar lateral anodal configuration (PERC QD) and (b) laminotomy lead with staggered quadripolar lateral anodal configuration (LAM QD), of the same contact dimensions. The commercially available LAM 565 surgical lead with 16 widely spaced contacts was also modeled. For comparison with PERC QD, staggered transverse tripoles with dual lateral anodes were modeled by using percutaneous lead with staggered dual lateral anodal configuration (PERC ST).

RESULTS: The PERC QD improved the depth of DC penetration and enabled selective recruitment of DCs in comparison with PERC ST. Mediolateral selectivity of DCs could not be achieved with the LAM 565.

CONCLUSION: Stimulation using PERC QD improves anodal shielding of dorsal roots and restores DC selectivity. Based on our modeling study, we hypothesize that, in clinical practice, LAM QD can provide an improved performance compared with the PERC QD. Our model also predicts that the same configuration realized on the commercial LAM 565 surgical lead with widely spaced contacts cannot selectively stimulate DCs essential in treating low-back pain.

ABBREVIATIONS: DC, dorsal column

dCSF, dorsomedial cerebrospinal fluid

DM, dura mater

DR, dorsal root

ES, epidural space

LAM QD, laminotomy lead with staggered quadripolar lateral anodal configuration

LAM 565, commercially available laminotomy lead with widely spaced staggered quadripolar lateral anodal configuration

PERC AL, percutaneous lead with aligned dual lateral anodal configuration

PERC QD, percutaneous lead with staggered quadripolar lateral anodal configuration

PERC ST, percutaneous lead with staggered dual lateral anodal configuration

SCS, spinal cord stimulation

UR, usage range

Author Information

MIRA, Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands

Correspondence: Vishwanath Sankarasubramanian, MSc, MIRA, Institute of Biomedical Technology and Technical Medicine, University of Twente, PO Box 217, Building Zuidhorst (ZH), Room ZH 211, 7500 AE, Enschede, The Netherlands. E-mail: vishwanath.sankar@gmail.com

Source of financial support: The authors thank Boston Scientific Neuromodulation (Valencia, California) for their grant to support this research.

Received April 21, 2012

Accepted October 19, 2012

Copyright © by the Congress of Neurological Surgeons