Long-term follow-up of spinal cord stimulation to restore cough in subjects with spinal cord injury

DiMarco, Anthony F.; Kowalski, Krzysztof E.; Hromyak, Dana R.; Geertman, Robert T.

doi:10.1179/2045772313y.0000000152

Cited by 30 publications

(32 citation statements)

References 19 publications

(22 reference statements)

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“…A remote ground electrode was positioned in the back musculature. Since we have previously demonstrated, both in animal 24,25 and human 20,21 studies, that any combination of two of the three spinal cord levels tested (T9, T11, and L1) resulted in maximum pressure generation, we focused our evaluation to stimulation of each site individually and the simultaneous stimulation of various combinations of two sites. The effects of both monopolar and bipolar stimulation were also evaluated.…”

Section: Methodsmentioning

confidence: 99%

“…Since monopolar SCS with the disc leads, when applied in clinical trials, 20,21 resulted in airway pressure generation that approximated pressures generated with a normal maximum cough, airway pressure generation achieved during SCS with these leads served as our gold standard to which all comparisons were made. Data are reported as mean ± SE.…”

Section: Data and Statistical Analysesmentioning

confidence: 99%

“…In recent human studies, we demonstrated that an effective cough can be restored in subjects with SCI via stimulation of electrodes positioned on the lower thoracic and upper lumbar spinal cord. [20][21][22] This procedure involves the placement of disc leads at the T9, T11, and L1 spinal cord levels on the dorsal epidural surface via laminotomy incisions, and a ground electrode positioned in the subcutaneous tissue. This method is successful in achieving an effective means of secretion clearance, as demonstrated by the generation of large airway pressures and peak expiratory airflow rates, which approximate values observed during maximum cough efforts in normal people.…”

Section: Introductionmentioning

confidence: 99%

“…This method is successful in achieving an effective means of secretion clearance, as demonstrated by the generation of large airway pressures and peak expiratory airflow rates, which approximate values observed during maximum cough efforts in normal people. 20,21 Importantly, this technique significantly facilitates airway clearance, reduces the difficulty in raising secretions, reduces the need for caregiver support for secretion management, reduces the incidence of respiratory tract infections, and improves life quality. 20,22 While successful in restoring an effective cough in each subject, this technique requires an invasive procedure for disc lead placement (typically, 4-6 hours of operating room time) and 2-3-day hospital admission.…”

Section: Introductionmentioning

confidence: 99%

“…20,21 Importantly, this technique significantly facilitates airway clearance, reduces the difficulty in raising secretions, reduces the need for caregiver support for secretion management, reduces the incidence of respiratory tract infections, and improves life quality. 20,22 While successful in restoring an effective cough in each subject, this technique requires an invasive procedure for disc lead placement (typically, 4-6 hours of operating room time) and 2-3-day hospital admission. As a result, this method entails the potential for significant risk, including bleeding, infection, and discomfort, in an already compromised patient population.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of wire and disc leads to activate the expiratory muscles in dogs

Kowalski

DiMarco

2011

The Journal of Spinal Cord Medicine

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Objective: Respiratory complications account for a major cause of morbidity and mortality in subjects with spinal cord injury (SCI) due to paralysis of the expiratory muscles and the consequent inability to generate effective cough. We demonstrated previously that effective cough can be restored in SCI via spinal cord stimulation (SCS) with disc leads positioned on the lower thoracic and upper lumbar spinal cord via laminotomy incisions. In this study, the effectiveness of wire leads, which can be placed using minimally invasive techniques, to activate the expiratory muscles was evaluated. Design: Animal study. Setting: Research laboratory. Animals: Dogs (n = 8).Interventions: In separate trials, disc and wire leads were inserted onto the dorsal epidural space at the T9, T11, and L1 spinal cord levels. Effects of electrical stimulation with disc, single wire, and two wire leads placed in parallel were compared. Outcome measures: Airway pressure generation following stimulation with disc and various configurations of wire leads were compared. Results: Several different configurations of wire leads resulted in airway pressures that were similar to those generated with monopolar stimulation with disc leads (MSDLs). For example, combined monopolar stimulation with parallel wire leads at the T9 + T11 and T9 + L1 levels resulted in airway pressures that were 103.5 ± 6.4 and 101.9 ± 7.0%, respectively, of those achieved with MSDL. Bipolar stimulation with parallel wire leads at T9-T11 and T9-L1 resulted in airway pressures that were 94.2 ± 3.4 and 96.8 ± 5.0%, respectively, of the pressures achieved with MSDL. Other wire configurations were also evaluated, but were generally less effective. Conclusion: These results suggest that specific configurations of wire leads, which can be placed via minimally invasive techniques, result in comparable activation of the expiratory muscles compared to disc leads and may be a useful technique to restore cough in persons with SCI.

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