Computational Study of the Effect of Electrode Polarity on Neural Activation Related to Paresthesia Coverage in Spinal Cord Stimulation Therapy

Durá, J. L. Quiles; Solanes, Carmen; Andrés, José De; Sáiz, Javier

doi:10.1111/ner.12909

Cited by 11 publications

(27 citation statements)

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“…2.1.1. Generalized spinal cord model The generalized model [16] consists of the following tissues: white and grey matter, cerebrospinal fluid (CSF), dura mater, epidural [27] fat and bone (see figures 1a and 1b). The electrical conductivity of the different tissues are shown in Table 1.…”

Section: Volume Conductor Modelsmentioning

confidence: 99%

“…For example, in 2014, two spinal cord models were created as extrusions of average adult human lower thoracic measurements obtained from preoperative patients' MRI [14,15]. In 2018 our research group developed a T10 vertebral level spinal cord model [16]. The novelty of this generalized model was that it included the spinal cord offset in the spinal canal and the geometrical parameters were taken from in vivo high-resolution human spinal cord measurements [17].…”

Section: Introductionmentioning

confidence: 99%

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3D patient-specific spinal cord computational model for SCS management: potential clinical applications

et al. 2021

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Objective. Although spinal cord stimulation (SCS) is an established therapy for treating neuropathic chronic pain, in tonic stimulation, postural changes, electrode migration or badly-positioned electrodes can produce annoying stimulation (intercostal neuralgia) in about 35% of the patients. SCS models are used to study the effect of electrical stimulation to better manage the stimulation parameters and electrode position. The goal of this work was to develop a realistic 3D patient-specific spinal cord model from a real patient and develop a future clinical application that would help physicians to optimize paresthesia coverage in SCS therapy. Approach. We developed two 3D patient-specific models from a high-resolution MRI of two patients undergoing SCS treatment. The model consisted of a finite element model of the spinal cord and a sensory myelinated nerve fiber model. The same simulations were performed with a generalized spinal cord model and we compared the results with the clinical data to evaluate the advantages of a patient-specific model. To identify the geometrical parameters that most influence the stimulation predictions, a sensitivity analysis was conducted. We used the patient-specific model to perform a clinical application involving the pre-implantation selection of electrode polarity and study the effect of electrode offset. Main results. The patient-specific model correlated better with clinical data than the generalized model. Electrode-dura mater distance, dorsal cerebrospinal fluid (CSF) thickness, and CSF diameter are the geometrical parameters that caused significant changes in the stimulation predictions. Electrode polarity could be planned and optimized to stimulate the patient’s painful dermatomes. The addition of offset in parallel electrodes would not have been beneficial for one of the patients of this study because they reduce neural activation displacement. Significance. This is the first study to relate the activation area model prediction in dorsal columns with the clinical effect on paresthesia coverage. The outcomes show that 3D patient-specific models would help physicians to choose the best stimulation parameters to optimize neural activation and SCS therapy in tonic stimulation.

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Section: Volume Conductor Modelsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

3D patient-specific spinal cord computational model for SCS management: potential clinical applications

et al. 2021

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“…Models of SCS have been continuously refined and applied from the early 80's through recent efforts 1,2,5,10,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] (see Table 1). Development of models of increasing complexity offered mirrored general enhancements in numerical modeling techniques (finite element analysis), with proprietary efforts by numerous groups, each subject to multiple version iterations.…”

Section: Broad Impact Of An Open-source High-resolution Computationalmentioning

confidence: 99%

“…Durá et al, 2019 developed a simplified 3D SCS model at the T10 spine level with basic anatomical precision in vertebrae, epidural fat, dura mater, CSF, while both white-matter and gray-matter had moderate anatomical precision. Modeled DR fibers had limited anatomical precision 19 . In 2018, Kent and colleagues developed a 3D dorsal root ganglion (DRG) model with basic anatomical precision of the dorsal root and the DRG, and limited precision in epidural tissues and vertebrae 4 6 .…”

Section: Anatomical Details Of Prior Scs Modelsmentioning

confidence: 99%

Realistic Anatomically Detailed Open-Source Spinal Cord Stimulation (RADO-SCS) Model

Khadka

Liu

Zander

et al. 2019

Preprint

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Objective: Computational current flow models of spinal cord stimulation (SCS) are widely used in device development, clinical trial design, and patient programming. Proprietary models of varied sophistication have been developed. An open-source model with state-of-the-art precision would serve as a standard for SCS simulation. Approach:We developed a sophisticated SCS modeling platform, named Realistic Anatomically Detailed Open-Source Spinal Cord Stimulation (RADO-SCS) model. This platform consists of realistic and detailed spinal cord and ancillary tissues anatomy derived based on prior imaging and cadaveric studies. Represented tissues within the T9-T11 spine levels include vertebrae, intravertebral discs, epidural space, dura, CSF, white-matter, gray-matter, dorsal and ventral roots and rootlets, dorsal root ganglion, sympathetic chain, thoracic aorta, epidural space vasculature, white-matter vasculature, and thorax. As an exemplary, a bipolar SCS montage was simulated to illustrate the model workflow from the electric field calculated from a finite element model (FEM) to activation thresholds predicted for individual axons populating the spinal cord.Main Results: Compared to prior models, RADO-SCS meets or exceeds detail for every tissue compartment. The resulting electric fields in white and gray-matter, and axon model activation thresholds are broadly consistent with prior stimulations. Significance:The RADO-SCS can be used to simulate any SCS approach with both unprecedented resolution (precision) and transparency (reproducibility). Freely available online, the RADO-SCS will be updated continuously with version control.

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“…He tenido que esperar once años para, con el apoyo de una pequeña empresa valenciana, y sobre todo de mis directores de tesis el Dr. Javier Saiz, con quien comparto mis inquietudes investigadoras desde el año 1991, y el Dr. José de Andrés, con quien llevo trabajando en la neuromodulación desde 1996, para poder desarrollar un modelo de simulación propio como el que hay en apenas unos cuantos centros de investigación en todo el mundo. Hasta donde llega mi conocimiento, el primer artículo comparando distintas polaridades de uso clínico habitual es el que publica nuestro grupo en 2019 (12).…”

Section: Figurasunclassified

Modelización de los efectos de la neuroestimulación medular

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Computational Study of the Effect of Electrode Polarity on Neural Activation Related to Paresthesia Coverage in Spinal Cord Stimulation Therapy

Cited by 11 publications

References 50 publications

3D patient-specific spinal cord computational model for SCS management: potential clinical applications

3D patient-specific spinal cord computational model for SCS management: potential clinical applications

Realistic Anatomically Detailed Open-Source Spinal Cord Stimulation (RADO-SCS) Model

Modelización de los efectos de la neuroestimulación medular

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