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Spinal cord stimulation with percutaneous and plate electrodes: side effects and quantitative comparisons
R B North1, A Lanning, R Hessels
1Department of Neurosurgery, School of Medicine, and Applied Physics Laboratory, Johns Hopkins University, Baltimore, Maryland 21287-7713, USA.
Neurosurgical Focus
|January 15, 1997
Summary
Uncomfortable side effects from spinal cord stimulation (SCS) can occur due to dorsal root stimulation or, as newly found, small fiber recruitment in the ligamentum flavum. Insulated plate electrodes effectively eliminate this discomfort, improving SCS therapy.
Area of Science:
- Neurosurgery
- Pain Management
- Biomedical Engineering
Background:
- Spinal cord stimulation (SCS) is a valuable treatment for chronic pain.
- Patient comfort during SCS is often limited by stimulation-induced side effects.
- Existing side effects are typically attributed to dorsal root stimulation.
Purpose of the Study:
- To investigate an alternative mechanism for stimulation-evoked discomfort during SCS.
- To identify the anatomical structures responsible for this discomfort.
- To evaluate electrode design modifications for improved patient comfort.
Main Methods:
- Seventy-nine patients with postsurgical lumbar pain syndromes were enrolled.
- Percutaneous electrodes were tested at thoracic levels T-8 to T-12.
- Insulated plate electrodes were compared with percutaneous electrodes, including inverted positioning.
Main Results:
- 46% of patients reported paravertebral discomfort with percutaneous electrodes, linked to ligamentum flavum stimulation.
- This discomfort was most common at T-8 and T-9 levels.
- Insulated plate electrodes eliminated this side effect, and inverted testing reproduced it, confirming the mechanism.
Conclusions:
- A significant subset of SCS-related discomfort stems from stimulating the ligamentum flavum via percutaneous electrodes.
- Insulated plate electrodes offer a solution by preventing circumferential current spread.
- This finding optimizes SCS electrode selection and improves patient outcomes.