title: Staggered transverse tripoles with quadripolar lateral anodes using percutaneous and surgical leads in spinal cord stimulation.
abstract: BACKGROUND
  In spinal cord stimulation for low-back pain, the use of electrode arrays with both low-power requirements and selective activation of target dorsal column (DC) fibers is desired. The aligned transverse tripolar lead configuration offers the best DC selectivity. Electrode alignment of the same configuration using 3 parallel percutaneous leads is possible, but compromised by longitudinal migration, resulting in loss of DC selectivity. This loss might be repaired by using the adjacent anodal contacts on the lateral leads.
  
  
  OBJECTIVE
  To investigate if stimulation using adjacent anodal contacts on the lateral percutaneous leads of a staggered transverse tripole can restore DC selectivity.
  
  
  METHODS
  Staggered transverse tripoles with quadripolar lateral anodes were modeled on the low-thoracic vertebral region (T10-T12) of the spinal cord using (a) percutaneous lead with staggered quadripolar lateral anodal configuration (PERC QD) and (b) laminotomy lead with staggered quadripolar lateral anodal configuration (LAM QD), of the same contact dimensions. The commercially available LAM 565 surgical lead with 16 widely spaced contacts was also modeled. For comparison with PERC QD, staggered transverse tripoles with dual lateral anodes were modeled by using percutaneous lead with staggered dual lateral anodal configuration (PERC ST).
  
  
  RESULTS
  The PERC QD improved the depth of DC penetration and enabled selective recruitment of DCs in comparison with PERC ST. Mediolateral selectivity of DCs could not be achieved with the LAM 565.
  
  
  CONCLUSIONS
  Stimulation using PERC QD improves anodal shielding of dorsal roots and restores DC selectivity. Based on our modeling study, we hypothesize that, in clinical practice, LAM QD can provide an improved performance compared with the PERC QD. Our model also predicts that the same configuration realized on the commercial LAM 565 surgical lead with widely spaced contacts cannot selectively stimulate DCs essential in treating low-back pain.
authors.affiliation: MIRA, Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands. vishwanath.sankar@gmail.com
authors.forename: Vishwanath
authors.initials: V
authors.lastname: Sankarasubramanian
authors.forename: Jan R
authors.initials: JR
authors.lastname: Buitenweg
authors.forename: Jan
authors.initials: J
authors.lastname: Holsheimer
authors.forename: Peter H
authors.initials: PH
authors.lastname: Veltink
mesh_terms: D003198:Computer Simulation; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D004566:Electrodes; D004567:Electrodes, Implanted; D006801:Humans; D007796:Laminectomy; D017116:Low Back Pain / Q000628:therapy; D008953:Models, Anatomic; D008959:Models, Neurological; D009412:Nerve Fibers / Q000502:physiology; D019635:Neurosurgical Procedures; D010292:Paresthesia / Q000209:etiology; D011999:Recruitment, Neurophysiological; D012984:Software; D013116:Spinal Cord / Q000502:physiology*; D062187:Spinal Cord Stimulation / Q000379:methods*; D013904:Thoracic Vertebrae; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*