title: Modeling effects of scar on patterns of dorsal column stimulation.
abstract: OBJECTIVE
  The purpose of this study was to examine how scar formation may affect electrical current distribution in the spinal cord when using paddle leads placed in the epidural space during treatment with spinal cord stimulation.
  
  
  METHODS
  A finite element model of the spinal cord was used to examine changes in stimulation using a guarded cathode configuration with and without scar. Additionally, two potential "compensatory" programming patterns were examined in order to understand how the three-dimensional electrical field may be affected by scar. Direct comparisons with prior studies in the literature and use of known anatomy of dorsal column fiber distributions also enabled a computational estimate of the number of fibers likely reaching threshold with each stimulus pattern.
  
  
  RESULTS
  Notable potential and current distribution changes were found related to the modeled scar. Compensatory stimulation patterns (both in spatial and in amplitude dimensions) affect the fiber activation patterns in complex ways that may not be easily predetermined by a programming specialist.
  
  
  CONCLUSIONS
  This study is one of the first to examine the effects of scar tissue on dorsal column stimulation and the only one using a detailed computational approach toward that end. It appears that different thickness and location of scar between electrode contacts and the dura may likely lead to a significant number and location of complex changes in the activated fibers. It is likely that a more complete assessment of scarring and its effect on the electrical environment of any given paddle lead would allow more accurate and predictable reprogramming of patients with commercially available systems in place.
authors.affiliation: Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurosurgery, Harvard Medical School, Boston, MA, USA.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Arle
authors.forename: Kris W
authors.initials: KW
authors.lastname: Carlson
authors.forename: Longzhi
authors.initials: L
authors.lastname: Mei
authors.forename: Jay L
authors.initials: JL
authors.lastname: Shils
mesh_terms: D002921:Cicatrix / Q000473:pathology*; D004567:Electrodes, Implanted; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods*; D008953:Models, Anatomic; D020671:Posterior Horn Cells / Q000473:pathology*; D062187:Spinal Cord Stimulation / Q000295:instrumentation / Q000379:methods*
keywords: dorsal column stimulation; finite element modeling; paddle lead; scar; spinal cord stimulation