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3D patient-specific spinal cord computational model for SCS management: potential clinical applications
Carmen Solanes1,2, Jose L Durá1,3, M Ángeles Canós4
1Center of Research and Innovation in Bioengineering (Ci2B), Universitat Politècnica de València, Valencia, Spain.
Journal of Neural Engineering
|February 8, 2021
Summary
Developing patient-specific spinal cord models improves spinal cord stimulation (SCS) therapy for chronic pain by optimizing electrode placement and stimulation parameters, leading to better paresthesia coverage and reduced side effects.
Area of Science:
- Biomedical Engineering
- Neuroscience
- Medical Imaging
Background:
- Spinal cord stimulation (SCS) effectively treats neuropathic pain but can cause side effects like intercostal neuralgia in up to 35% of patients due to issues with tonic stimulation, electrode positioning, or migration.
- Current SCS modeling approaches often use generalized models, which may not fully capture individual patient anatomy and its impact on stimulation outcomes.
Purpose of the Study:
- To develop realistic 3D patient-specific spinal cord models for optimizing spinal cord stimulation (SCS) therapy.
- To create a clinical application aiding physicians in optimizing paresthesia coverage and selecting stimulation parameters for SCS.
Main Methods:
- Two patient-specific 3D finite element models of the spinal cord and sensory myelinated nerve fibers were created from high-resolution MRI data.
- Simulations were performed using both patient-specific and generalized models, with results compared to clinical data and a sensitivity analysis conducted on geometrical parameters.
Main Results:
- Patient-specific models demonstrated a higher correlation with clinical data compared to generalized models.
- Key geometrical parameters influencing stimulation predictions included electrode-dura mater distance, dorsal cerebrospinal fluid (CSF) thickness, and CSF diameter.
- Electrode polarity optimization was shown to effectively target painful dermatomes, while electrode offset proved non-beneficial in specific patient cases.
Conclusions:
- 3D patient-specific spinal cord models offer a significant advantage over generalized models for predicting SCS outcomes.
- These models can guide physicians in selecting optimal stimulation parameters and electrode configurations to enhance neural activation and improve therapeutic efficacy in tonic SCS.
- This study establishes a link between computational modeling of dorsal column activation and the clinical effect of paresthesia coverage in SCS therapy.
