Modeling Effects of Scar on Patterns of Dorsal Column Stimulation
Modeling Effects of Scar on Patterns of Dorsal Column Stimulation
复制标题
DOI：
10.1111/ner.12128
复制
发表时间：
2014-06-01
期刊：
影响因子：
2.8
通讯作者：
Shils, Jay L.
中科院分区：
文献类型：
--
作者：
Arle, Jeffrey E.;Carlson, Kris W.;Shils, Jay L.
目的本研究的目的是检查在脊髓刺激治疗期间使用放置在硬膜外腔中的桨式引线时，疤痕形成如何影响脊髓中的电流分布。材料和方法使用脊髓的有限元模型来检查使用有或没有疤痕的保护阴极配置的刺激的变化。此外，还检查了两种潜在的补偿编程模式，以了解三维电场如何受到疤痕的影响。与文献中先前研究的直接比较以及使用已知的背柱纤维分布解剖结构也可以对每种刺激模式可能达到阈值的纤维数量进行计算估计。结果发现与建模疤痕相关的显着电位和电流分布变化。补偿性刺激模式（在空间和幅度维度上）以复杂的方式影响纤维激活模式，编程专家可能无法轻松预先确定这些模式。结论这项研究是第一个研究疤痕组织对背柱刺激影响的研究之一，也是唯一一个为此目的使用详细计算方法的研究。看来，电极触点和硬脑膜之间疤痕的不同厚度和位置可能会导致活化纤维中复杂变化的显着数量和位置。对疤痕及其对任何给定电极板电环境的影响进行更完整的评估可能会允许使用适当的商用系统对患者进行更准确和可预测的重新编程。
ObjectiveThe 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.Materials and MethodsA 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.ResultsNotable 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.ConclusionsThis 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.