Durotomy Surrogate and Seals for Intradural Spinal Cord Stimulators: Apparatus and Review of Clinical Methods and Materials

Nagel, Sean J.; Helland, Logan C.; Woodroffe, Royce W.; Frizon, Leonardo A.; Holland, Marshall T.; Machado, André G.; Yamaguchi, Satoshi; Gillies, G. T.; Howard, Matthew A.; Wilson, Saul

doi:10.1111/ner.12913

Cited by 6 publications

(2 citation statements)

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“…At its origins as a therapy, virtually all SCS was carried out by intradural implantation of the electrodes (65), but with the more minimally invasive epidural approaches eventually becoming the standard of care. Even so, recent work has now shown that significant improvements in selectivity of stimulation targets within the spinal cord might be achieved with intradural arrays (66,67), and efforts to develop clinically useful devices are underway (68,69). The ability to implant SCS devices intradurally suggests the unique opportunity of collateral CSF assay at the time of implantation for the purpose of optimizing the therapeutic strategies, via evaluation of several types of biomarkers such as those discussed in the "Chemically Sensing-Metabolites, Neurotransmitters, and Inflammatory Markers" section.…”

Section: Optimizations For Intradural Stimulationmentioning

confidence: 99%

Biomarker Optimization of Spinal Cord Stimulation Therapies

Nagel

Hsieh

Machado

et al. 2021

Neuromodulation: Technology at the Neural Interface

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Section: Optimizations For Intradural Stimulationmentioning

confidence: 99%

Biomarker Optimization of Spinal Cord Stimulation Therapies

Nagel

Hsieh

Machado

et al. 2021

Neuromodulation: Technology at the Neural Interface

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“…A fixation nut is used to secure closure of the durotomy by sandwiching the dura matter between the intradural and extradural plates. Each plate has a gasket consisting of a thin lining of either a dural substitute or some other suitable compressible material on the surfaces contacting the dura, in order to ensure a watertight seal with no significant risk of dural tissue necrosis (Nagel et al, 2019). The leads from the individual electrodes on the intradural array form a bundle that passes through the axial lumen of the threaded stud.…”

Section: Introductionmentioning

confidence: 99%

Intradural Spinal Cord Stimulation: Performance Modeling of a New Modality

et al. 2019

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Introduction: Intradural spinal cord stimulation (SCS) may offer significant therapeutic benefits for those with intractable axial and extremity pain, visceral pain, spasticity, autonomic dysfunction and related disorders. A novel intradural electrical stimulation device, limited by the boundaries of the thecal sac, CSF and spinal cord was developed to test this hypothesis. In order to optimize device function, we have explored finite element modeling (FEM).Methods: COMSOL®Multiphysics Electrical Currents was used to solve for fields and currents over a geometric model of a spinal cord segment. Cathodic and anodic currents are applied to the center and tips of the T-cross component of the electrode array to shape the stimulation field and constrain charge-balanced cathodic pulses to the target area.Results: Currents from the electrode sites can move the effective stimulation zone horizontally across the cord by a linear step method, which can be diversified considerably to gain greater depth of penetration relative to standard epidural SCS. It is also possible to prevent spread of the target area with no off-target action potential.Conclusion: Finite element modeling of a T-shaped intradural spinal cord stimulator predicts significant gains in field depth and current shaping that are beyond the reach of epidural stimulators. Future studies with in vivo models will investigate how this approach should first be tested in humans.

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