Browse > Article

An Analysis of Paresthesia Areas Evoked by Spinal Cord Stimulation in Relation to the Position of Electrode Tip  

Lee, Mi Geum (Department of Anesthesiology, Seoul National University College of Medicine)
Lee, Hyo Min (Department of Anesthesiology, Seoul National University College of Medicine)
Jo, Ji Yon (Department of Anesthesiology, Seoul National University College of Medicine)
Choi, Yun Suk (Department of Anesthesiology, Seoul National University College of Medicine)
Ku, Ui Kyoung (Department of Anesthesiology, Seoul National University College of Medicine)
Lee, Chul Joong (Department of Anesthesiology, Seoul National University College of Medicine)
Lee, Sang Chul (Department of Anesthesiology, Seoul National University College of Medicine)
Kim, Yong Chul (Department of Anesthesiology, Seoul National University College of Medicine)
Publication Information
The Korean Journal of Pain / v.19, no.2, 2006 , pp. 146-151 More about this Journal
Abstract
Background: Spinal cord stimulation is a well-established method for the management of several types of chronic and intractable pain. This form of stimulation elicits a tingling sensation (paresthesia) in the corresponding dermatomes. The goal of this study was to establish a correlation between the spinal levels of the implanted epidural electrodes and the paresthesia elicited due to stimulation of the neural structures. Methods: Thirty five patients, who received trial spinal cord stimulation, were evaluated. After the insertion of the lead to the selected position, the areas of paresthesia evoked by stimulation were evaluated. Results: Seventy-one percent of cases showed paresthesia in the shoulder area when the tip of the electrode was located between the C2⁣-C4 levels. At the upper extremities, paresthesia was evoked in 86⁣-93% of cases, regardless of the location of the electrode tip within the cervical spinal segments. The most common tip placement of the leads eliciting hand stimulation was at the C5 level. The most common level of electrode tip placement eliciting paresthesia of the anterior and posterior thigh and the foot were at the T7-⁣T12, T10⁣-L1 and T11-⁣L1 vertebral segments, respectively. Conclusions: Detailed knowledge of the patterns of stimulation induced paresthesia in relation to the spine level of the implanted electrodes has allowed the more consistent and successful placement of epidural electrodes at the desired spine level.
Keywords
lead position; sensory response; stimulation response;
Citations & Related Records
Times Cited By KSCI : 2  (Citation Analysis)
연도 인용수 순위
1 Melzack R: Acupuncture and pain mechanisms. Anaesthesist 1976;25: 204-7
2 Linderoth B, Fedorcsak I, Meyerson BA: Is vasodilatation following dorsal column stimulation mediated by antidromic activation of small diameter afferents? Acta Neurochir Suppl (Wien) 1989; 46: 99-101
3 Turner JA, Loeser JD, Deyo RA, Sanders SB: Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome: a systematic review of effectiveness and complications. Pain 2004; 108: 137-47   DOI   ScienceOn
4 Barolat G, Zeme S, Ketcik B: Multifactorial analysis of epidural spinal cord stimulation. Stereotact Funct Neurosurg 1991; 56: 77-103   DOI
5 HolsheimerJ, Wesselink WA: Optimum electrode geometry for spinal cord stimulation: the narrow bipole and ttipole. Med Biol Eng Comput 1997; 35: 493-7   DOI   ScienceOn
6 Larson SJ, Sances AJ, Riegel DH, Meyer GA, Dallmann DE, Swiontek T: Neurophysiological effects of dorsal column stimulation in man and monkey. J Neurosurg 1974; 41: 217-23   DOI
7 Lee SC: Electrical nerve stimulation. In: Pain medicine. 2nd ed. Edited by the Korean Pain Society: Seoul, Koonja Publishing Inc. 2000, pp 560-4
8 Khan YN, Raza SS, Khan EA: Application of spinal cord stimulation for the treatment of abdominal visceral pain syndromes: case reports. Neuromodulation 2005; 8: 14-27   DOI   ScienceOn
9 Shealy CN: Dorsal column stimulation: optimization of application. Surg Neurol 1975; 4: 142-5
10 Ala KM: Spinal cord stimulation for complex pain: initial experience with a dual electrode, programmable, internal pulse generator. Pain Practice 2003; 3: 31-8   DOI   ScienceOn
11 Barolat G, Massaro F, He J, Zeme S, Ketcik B: Mapping of sensory responses to epidural stimulation of the intraspinal Neurol strucrures in man. J Neurosurg 1993; 78: 233-9   DOI
12 Saade NE, Tabet MS, Soueidan SA, Bitar M, Atweh SF, Jabbur SJ: Supraspinal modulation of nociception in awake rats by stimulation of the dorsal column nuclei. Brain Res 1986; 369: 307-10   DOI   ScienceOn
13 North RE, Kidd DH, Zahurak M, James CS, Long DM: Spinal cord stimulation for chronic, intractable pain: experience over two decades. Neurosurgery 1993; 32: 384-95   DOI   ScienceOn
14 Handwerker HO, Iggo A, Zimmermann M: Segmental and supraspinal actions on dorsal horn neurons responding to noxious and non-noxious skin stimuli. Pain 1975; 1: 147-65   DOI   ScienceOn
15 Holsheimer J, Barolat G: Spinal geometry and paresthesia coverage in spinal cord stiniulation. Neuromodulation 1998; 1: 129-36   DOI
16 HolsheimerJ, Den boer JA, Struijk JJ, Rozeboom AR: MR assessment of the normal position of the spinal cord in the spinal canal. Am J Neuroradiol 1994; 15: 951-9
17 Oakley JC: Spinal cord stimulation in axial low back pain: solving the dilemma. Pain Medicine 2006; 7: S58-63   DOI   ScienceOn
18 Alo KM, Holsheimer J: New trends in neuromodulation for the management of neuropathic pain. Neurosurgery 2002; 50: 690-703   DOI