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Related Experiment Video

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Multimodal Spinal Cord Mapping during Spinal Cord Stimulator Placement: Technical Note.

Geoffrey Allott1, Satish Krishnamurthy2

  • 1Department of Intraoperative Neurophysiological Monitoring, SUNY Upstate Medical University, Syracuse, New York.

The Neurodiagnostic Journal
|December 17, 2021
PubMed
Summary

Multimodal spinal cord mapping (MSCM) enhances spinal cord stimulator (SCS) placement accuracy under general anesthesia. This technique integrates multiple neurophysiological signals, improving midline confirmation for safer, more precise surgeries.

Keywords:
Antidromic stimulationC3-C4 cancellationdorsal column stimulatorneuromonitoringneurophysiologyspinal cord stimulator

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Area of Science:

  • Neurosurgery
  • Neurophysiology
  • Pain Management

Background:

  • Spinal cord stimulation (SCS) treats severe neuropathic and back pain.
  • SCS placement occurs under sedation or general anesthesia (GA).
  • Accurate SCS placement is crucial for effective pain relief and minimizing complications.

Purpose of the Study:

  • To evaluate multimodal spinal cord mapping (MSCM) for SCS placement under GA.
  • To adapt precise neuromonitoring techniques used for spinal cord tumors to SCS procedures.
  • To enhance the safety and accuracy of SCS implantation through advanced mapping.

Main Methods:

  • Integrated recordings from multiple antidromic and orthodromic generators for MSCM.
  • Utilized somatosensory cortex responses (Cp3-Cp4 cancellation) and SCS-induced peripheral nerve action potentials.
  • Applied techniques typically used for localizing the dorsal spinal cord midline in tumor cases.

Main Results:

  • Demonstrated the feasibility of MSCM for SCS placement under GA.
  • Observed anti D-wave responses, potentially equivalent to D-waves.
  • Identified potential misclassification of compound muscle action potentials as compound nerve action potentials in prior studies.

Conclusions:

  • MSCM provides neurophysiologists with enhanced information for confident midline SCS placement.
  • This approach allows for the application of specialized spinal cord tumor localization techniques during SCS procedures.
  • Facilitates neurophysiologist proficiency and enables future research into optimal mapping methods.