MIRA, Institute for Biomedical Technology and Technical Medicine, University of Twente, Drienerlolaan 5, Building Zuidhorst 211, 7522 NB, Enschede, The Netherlands.
J Neural Eng. 2011 Feb;8(1):016010. doi: 10.1088/1741-2560/8/1/016010. Epub 2011 Jan 19.
The aim of this modeling study is to determine the influence of electrode alignment of transverse tripoles on the paresthesia coverage of the pain area in spinal cord stimulation, using a percutaneous triple-lead approach. Transverse tripoles, comprising a central cathode and two lateral anodes, were modeled on the low-thoracic vertebral region (T10-T12) using percutaneous triple-lead configurations, with the center lead on the spinal cord midline. The triple leads were oriented both aligned and staggered. In the staggered configuration, the anodes were offset either caudally (caudally staggered) or rostrally (rostrally staggered) with respect to the midline cathode. The transverse tripolar field steering with the aligned and staggered configurations enabled the estimation of dorsal column fiber thresholds (I(DC)) and dorsal root fiber thresholds (I(DR)) at various anodal current ratios. I(DC) and I(DR) were considerably higher for the aligned transverse tripoles as compared to the staggered transverse tripoles. The aligned transverse tripoles facilitated deeper penetration into the medial dorsal columns (DCs). The staggered transverse tripoles always enabled broad and bilateral DC activation, at the expense of mediolateral steerability. The largest DC recruited area was obtained with the rostrally staggered transverse tripole. Transverse tripolar geometries, using percutaneous leads, allow for selective targeting of either medial or lateral DC fibers, if and only if the transverse tripole is aligned. Steering of anodal currents between the lateral leads of the staggered transverse tripoles cannot target medially confined populations of DC fibers in the spinal cord. An aligned transverse tripolar configuration is strongly recommended, because of its ability to provide more post-operative flexibility than other configurations.
本建模研究旨在确定经皮三导联方法中横向三叉电极排列对脊髓刺激中疼痛区域感觉异常覆盖的影响。在低胸段（T10-T12）使用经皮三导联配置对横向三叉电极进行建模，中心导联位于脊髓中线。三导联排列方式有对齐和交错两种。在交错配置中，阳极相对于中线阴极向头侧（头侧交错）或尾侧（尾侧交错）偏移。对齐和交错配置的横向三叉极场转向可估算不同阳极电流比下背柱纤维阈值（I(DC)）和背根纤维阈值（I(DR)）。与交错横向三叉极相比，对齐横向三叉极的 I(DC)和 I(DR)明显更高。对齐横向三叉极更有利于向内侧背柱（DC）深部穿透。交错横向三叉极始终能够实现广泛的双侧 DC 激活，但牺牲了中侧 steerability。使用头侧交错横向三叉极可获得最大的 DC 募集面积。使用经皮导联的横向三叉极几何形状允许选择性靶向内侧或外侧 DC 纤维，如果横向三叉极对齐的话。交错横向三叉极的外侧导联之间的阳极电流转向不能靶向脊髓中受限制的 DC 纤维群体。由于其能够提供比其他配置更多的术后灵活性，因此强烈推荐使用对齐的横向三叉极配置。
