Theoretical performance and clinical evaluation of transverse tripolar spinal cord stimulation.
A new type of spinal cord stimulation electrode, providing contact combinations with a transverse orientation, is presented. Electrodes were implanted in the cervical area (C4-C5) of two chronic pain patients and the stimulation results were subsequently simulated with a computer model consisting of a volume conductor model and active nerve fiber models. For various contact combinations a good match was obtained between the modeling results and the measurement data with respect to load resistance (less than 20% difference), perception thresholds (16% difference), asymmetry of paresthesia (significant correlation) and paresthesia distributions (weak correlation). The transversally oriented combinations provided the possibility to select either a preferential dorsal column stimulation, a preferential dorsal root stimulation or a mixed stimulation. The (a)symmetry of paresthesia could largely be affected in a predictable way by the selection of contact combinations as well. The transverse tripolar combination was shown to give a higher selectivity of paresthesia than monopolar and longitudinal dipolar combinations, at the cost of an increased current (more than twice).
Struijk
J J
JJ
Center for Sensory Motor Interaction, Aalborg University, Denmark.
Holsheimer
J
J
Spincemaille
G H
GH
Gielen
F L
FL
Hoekema
R
R
D000328:Adult; D002908:Chronic Disease; D003198:Computer Simulation; D017097:Electric Impedance; D004599:Electric Stimulation Therapy; D004867:Equipment Design; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D059408:Pain Management; D010292:Paresthesia / Q000628:therapy; D016896:Treatment Outcome