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Postural Changes in Spinal Cord Stimulation Thresholds: Current and Voltage Sources.

Richard B North1, Jung H Sung2, Liam A Matthews3

  • 1Neuromodulation Foundation, Inc, Baltimore, MD; Departments of Neurosurgery, Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.

Neuromodulation : Journal of the International Neuromodulation Society
|October 7, 2023
PubMed
Summary
This summary is machine-generated.

Spinal cord stimulation (SCS) thresholds change with body position, especially for constant-current devices. Postural shifts increase stimulation levels, potentially causing discomfort, impacting SCS device management.

Keywords:
Chronic painelectric stimulationneuromodulationneuropathic painspinal cord stimulation

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Area of Science:

  • Neuromodulation
  • Biomedical Engineering
  • Pain Management

Background:

  • Spinal cord stimulation (SCS) thresholds vary with patient posture.
  • Characterizing these changes is crucial for both conventional and novel SCS technologies.
  • Understanding posture-induced threshold shifts informs SCS device optimization.

Purpose of the Study:

  • To quantify psychophysical threshold changes in SCS due to body position.
  • To compare these changes between constant-voltage and constant-current SCS generators.
  • To evaluate the impact of posture on stimulation-evoked discomfort.

Main Methods:

  • 149 patients with temporary SCS electrodes were assessed.
  • Perceptual, usage, and discomfort thresholds were measured in four body positions.
  • Data were analyzed for 119 constant-voltage and 30 constant-current stimulators.

Main Results:

  • Moving from supine to upright positions increased thresholds by 22-34% (constant-voltage) and 44-82% (constant-current).
  • Constant-current stimulators led to significantly more instances of exceeding the discomfort threshold (87% vs. 63%).
  • Posture-induced threshold changes were more pronounced with constant-current devices.

Conclusions:

  • Posture significantly alters SCS thresholds, with greater effects in constant-current systems.
  • Increased thresholds and discomfort in upright positions have clinical implications for SCS programming.
  • Findings support imaging and modeling studies of spinal cord positioning and neural recruitment.