Triple leads programmed to perform as longitudinal guarded cathodes in spinal cord stimulation: a modeling study

Area of Science:

• Neuromodulation
• Spinal Cord Stimulation
• Neuroscience

Background:

• Neurosurgeons increasingly use dual leads for spinal cord stimulation (SCS) to achieve medio-lateral control.
• Current dual lead configurations can result in suboptimal dorsal column (DC) recruitment compared to single midline leads.
• A novel approach is needed to enhance DC coverage with multi-lead SCS systems.

Purpose of the Study:

• To model a triple lead configuration for SCS in the low-thoracic region (T10-T12).
• To evaluate if a triple lead system can maximize the medio-lateral extent of DC recruitment.
• To compare the efficacy of triple leads against single and dual lead configurations.

Main Methods:

• Utilized the University of Twente Spinal Cord Stimulation (UT-SCS) software for modeling.
• Simulated percutaneous triple lead configurations with longitudinal guarded cathodes at T10-T12.
• Varied transverse distances between midline and lateral leads, and tested constant vs. variable anodal current ratios.

Main Results:

• Decreasing transverse lead separation increased the depth and width of the recruited DC area.
• The triple lead configuration with minimal separation yielded the largest DC recruited area and usage range.
• Variable anodal current ratios consistently produced larger DC areas than constant ratios.

Conclusions:

• Triple leads, programmed as longitudinal guarded cathodes, offer greater postoperative flexibility than single or dual leads.
• This configuration significantly enhances coverage of the low-thoracic dorsal columns.
• Transverse lead separation is a critical factor influencing the area and distribution of SCS-induced paresthesia.