Intraoperative electrical stimulation of the human dorsal spinal cord reveals a map of arm and hand muscle responses.
Intraoperative electrical stimulation of the human dorsal spinal cord reveals a map of arm and hand muscle responses.
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DOI：
10.1152/jn.00235.2022
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发表时间：
2023-01-01
影响因子：
2.5
通讯作者：
中科院分区：
文献类型：
--
作者：
尽管硬膜外刺激腰脊髓已成为恢复运动的一种有效方式，但如何针对颈脊髓激活手臂和手部肌肉尚不清楚，特别是在人类中。我们试图绘制肌肉对人类硬膜外后颈脊髓刺激的反应。我们假设侧向刺激在背根进入区是最有效的，并且在受刺激节段支配的肌肉中反应最强。26名接受临床指示颈椎手术的患者同意绘制运动反应图。在手术中，在多个暴露节段的中线和外侧位置进行刺激；在身体两侧分别记录6块手臂肌肉和3块腿部肌肉。在所有测试的节段和肌肉中，尽管反应的潜伏期和形状相似，但横向刺激产生的肌肉反应比中线刺激更强。神经支配于颈节段的肌肉对该节段的刺激反应最大，但在神经支配于其他颈节段的肌肉和腿部肌肉中也观察到反应。宫颈反应集中在颈侧（C4-C6）和尾侧（C7-T1）颈椎节段。对侧刺激的强烈反应可能是由于刺激靠近传入轴突。邻近颈椎节段刺激反应大小的微小变化表明局部电路整合，而远端肌肉反应表明长本体脊髓连接的激活。这张图可以帮助指导颈椎刺激，改善手臂和手的功能。新的和值得注意的是，在临床手术中，肌肉对宫颈硬膜外刺激的反应图显示，与中线刺激相比，横向刺激时激活最强，而不同节段之间的差异比预期的要弱。相反，当刺激中线和横向时，波形形状和潜伏期最相似，表明重叠电路被激活。因此，颈脊髓图揭示了组织，并可能有助于指导刺激，以强烈和有选择地激活手臂和手部肌肉。
Although epidural stimulation of the lumbar spinal cord has emerged as a powerful modality for recovery of movement, how it should be targeted to the cervical spinal cord to activate arm and hand muscles is not well understood, particularly in humans. We sought to map muscle responses to posterior epidural cervical spinal cord stimulation in humans. We hypothesized that lateral stimulation over the dorsal root entry zone would be most effective and responses would be strongest in the muscles innervated by the stimulated segment. Twenty-six people undergoing clinically indicated cervical spine surgery consented to mapping of motor responses. During surgery, stimulation was performed in midline and lateral positions at multiple exposed segments; six arm and three leg muscles were recorded on each side of the body. Across all segments and muscles tested, lateral stimulation produced stronger muscle responses than midline despite similar latency and shape of responses. Muscles innervated at a cervical segment had the largest responses from stimulation at that segment, but responses were also observed in muscles innervated at other cervical segments and in leg muscles. The cervical responses were clustered in rostral (C4–C6) and caudal (C7–T1) cervical segments. Strong responses to lateral stimulation are likely due to the proximity of stimulation to afferent axons. Small changes in response sizes to stimulation of adjacent cervical segments argue for local circuit integration, and distant muscle responses suggest activation of long propriospinal connections. This map can help guide cervical stimulation to improve arm and hand function. NEW & NOTEWORTHY A map of muscle responses to cervical epidural stimulation during clinically indicated surgery revealed strongest activation when stimulating laterally compared to midline and revealed differences to be weaker than expected across different segments. In contrast, waveform shapes and latencies were most similar when stimulating midline and laterally, indicating activation of overlapping circuitry. Thus, a map of the cervical spinal cord reveals organization and may help guide stimulation to activate arm and hand muscles strongly and selectively.
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影响因子：
4.6
作者：
Freyvert Y;Yong NA;Morikawa E;Zdunowski S;Sarino ME;Gerasimenko Y;Edgerton VR;Lu DC
通讯作者：
Lu DC
DOI：
10.1109/tnsre.2021.3049133
发表时间：
2021-01-01
影响因子：
4.9
作者：
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通讯作者：
Moritz, Chet T.
影响因子：
3.7
作者：
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通讯作者：
Minassian K
影响因子：
2.2
作者：
Ko, HY;Park, JH;Baek, SY
通讯作者：
Baek, SY
影响因子：
5.3
作者：
Capogrosso, Marco;Wenger, Nikolaus;Micera, Silvestro
通讯作者：
Micera, Silvestro