Theoretical Investigation Into Longitudinal Cathodal Field Steering in Spinal Cord Stimulation

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

“…Wesselink et al included white matter anisotropy and encapsulation layer between the electrode and dura precision 3D SCS model that included vertebrae, epidural fat, dura, CSF, gray-matter, white-matter, and general thorax in the FEM. They also modelled DR fibers as a cable model 40,41 . A more sophisticated computer-aided design (CAD)derived SCS model was developed in 2010 by Ladenbauer and colleagues and Danner and colleagues in 2011 for non-invasive and invasive SCS with a vertebral column of moderate precision 26,42 .…”

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

“…The neurophysiological mechanisms involved in SCS were first described by Melzack and Wall through the gate control theory of pain . These authors postulated that by selectively activating Aβ fibers by electrical stimulation, the “gate” could be electively closed, thus reducing painful inputs toward the brain and eliciting a tingling sensation (paresthesia) in pain dermatomes . Other subsequently proposed mechanisms of action maintain the same necessary condition of Aβ fiber stimulation to overlap the sensation of paresthesia on the perceived areas of pain .…”

“…The advantage of the FEM is that the solution region is considered to be built up of many small, interconnected subregions (finite elements), thus enabling the problem to be replaced by a simpler one when attempting to find a solution . Therefore, the best known FEM model of SCS was developed by Holsheimer , whose main studies were related to the neural structures involved in inducing paresthesia and the effect of electrode configuration on their activation . However, next‐generation computational models were more sophisticated, and studies were focused on the effect of the stimulation parameters on neural stimulation .…”

Model-based stimulation optimization for chronic pain suppression using percutaneous and surgical leads in spinal cord stimulation (SCS)

“…With the development of systems that can deliver stimulation using two leads, many physicians now routinely prefer dual leads, for the following reasons: (1) in the event of lateral lead migration, stimulation can be electronically transferred horizontally (either medially or laterally) between the leads to recapture the sweet spot, (2) in patients with bilateral extremity pain, placing each lead slightly off the midline greatly facilitates the perception of stimulation evenly felt in both extremities (56)(57)(58). Moreover, as has been shown in computer modeling studies, dual leads placed next to each other, straddling the physiologic midline can superimpose the electric fields effectively and achieve ample penetration into the midline of the DCs (59). The earliest experiments with three implanted percutaneous leads were performed by Prager and Chang.…”