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Dorsal Column Steerability with Dual Parallel Leads using Dedicated Power Sources: A Computational Model
Published on: February 10, 2011
Technical performance of percutaneous leads for spinal cord stimulation: a modeling study
Ljubomir Manola1, Jan Holsheimer, Peter Veltink
1Institute for Biomedical Technology, Department of Electrical Engineering, University of Twente, Enschede, The Netherlands.
Neuromodulation : Journal of the International Neuromodulation Society
|December 14, 2011
Summary
For spinal cord stimulation, the Advanced Bionics (AB) lead offers greater nerve fiber recruitment but uses more energy. Optimal pain treatment involves centered, tripolar leads outside the dura mater for extensive dorsal column fiber recruitment.
Area of Science:
- Biomedical Engineering
- Neurosurgery
- Pain Management
Background:
- Percutaneous leads are crucial for spinal cord stimulation (SCS) in treating complex pain syndromes.
- Technical performance variations among different lead types can impact SCS efficacy.
- Understanding lead placement and programming is essential for optimizing therapeutic outcomes.
Purpose of the Study:
- To compare the technical performance of various percutaneous lead types used in spinal cord stimulation.
- To evaluate the influence of lead placement and configuration on nerve fiber recruitment and energy consumption.
- To identify optimal lead characteristics for treating complex pain syndromes.
Main Methods:
- Simulation of four percutaneous lead models (PQ, PC, PP, AB) using ut-scs software.
- Modeling monopolar and tripolar (guarded cathode) configurations in various positions (midline, lateral, dorsal).
- Analysis of dual lead configurations and calculation of performance parameters for quantitative comparison.
Main Results:
- The AB lead demonstrated ~25% greater dorsal column fiber recruitment than the PQ lead but with ~160% higher energy consumption.
- Lead displacement (off-midline or dorsal) and dual lead configurations reduced dorsal column fiber recruitment compared to a single, centered lead.
- The PP lead was found suitable only for dorsal root stimulation.
Conclusions:
- For complex pain syndromes, leads with small contact spacing, programmed as a guarded cathode and centered outside the dura mater, provide the most extensive dorsal column fiber recruitment.
- Optimal lead placement and configuration are critical for maximizing therapeutic benefit in spinal cord stimulation.
- Increased dorsal column fiber recruitment is associated with higher energy consumption.
