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Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury

Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury

Published on: February 1, 2018

Postural changes in spinal cord stimulation perceptual thresholds.

J C Olin¹, D H Kidd, R B North

¹Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Neuromodulation : Journal of the International Neuromodulation Society

|December 14, 2011

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Spinal cord stimulation (SCS) voltage needs increase significantly when patients move from lying down to sitting or standing. This 11-25% rise impacts SCS device design and patient therapy.

Area of Science:

Neuromodulation
Biomedical Engineering
Pain Management

Background:

Spinal cord stimulation (SCS) is a common treatment for chronic pain.
Variations in SCS voltage thresholds with patient posture are known but not well-quantified.
Understanding these variations is crucial for optimizing SCS therapy.

Purpose of the Study:

To quantitatively characterize changes in SCS voltage thresholds across different body positions.
To determine the magnitude and consistency of posture-related voltage threshold shifts.
To inform SCS system design and clinical programming protocols.

Main Methods:

Prospective case series design involving 42 patients with percutaneous dorsal epidural leads.
Measurement of SCS voltage thresholds at the perception level in supine, sitting, and standing positions.

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Statistical analysis to assess the significance and nature of voltage changes.

Main Results:

A statistically significant increase (p=0.000) in SCS voltage requirements was observed when transitioning from supine to upright postures.
The increase in voltage demonstrated a linear relationship with baseline amplitudes, characterized by a slope of 1.25.
Ninety-five percent of patients exhibited a voltage increase, with the majority experiencing an 11-25% rise.

Conclusions:

Patient posture significantly affects SCS voltage thresholds, necessitating adjustments in clinical practice.
The observed linear increase suggests a predictable physiological response to postural changes.
Findings have direct implications for SCS device programming, lead design, and patient management strategies to ensure consistent therapeutic efficacy.