Kowalski Krysztof E, DiMarco Anthony F
Department of Physiology & Biophysics, Case Western Reserve University, Cleveland, OH, USA.
J Spinal Cord Med. 2011 Nov;34(6):600-8. doi: 10.1179/2045772311Y.0000000039.
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.
Animal study.
Research laboratory.
Dogs (n = 8).
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.
Airway pressure generation following stimulation with disc and various configurations of wire leads were compared.
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.
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.
由于呼气肌麻痹以及随之而来的无法产生有效咳嗽，呼吸并发症是脊髓损伤（SCI）患者发病和死亡的主要原因。我们之前证明，通过椎板切开术在胸段下部和腰段上部脊髓放置盘状电极进行脊髓刺激（SCS），可恢复SCI患者的有效咳嗽。在本研究中，评估了可采用微创技术放置的线状电极激活呼气肌的有效性。
动物研究。
研究实验室。
犬（n = 8）。
在单独的试验中，将盘状电极和线状电极插入T9、T11和L1脊髓节段的硬脊膜外间隙。比较盘状电极、单根线状电极和两根平行放置的线状电极进行电刺激的效果。
比较盘状电极和各种线状电极配置刺激后产生的气道压力。
几种不同配置的线状电极产生的气道压力与盘状电极单极刺激（MSDLs）产生的气道压力相似。例如，T9 + T11和T9 + L1水平的平行线状电极联合单极刺激产生的气道压力分别为MSDLs所产生气道压力的103.5±6.4%和101.9±7.0%。T9 - T11和T9 - L1水平的平行线状电极双极刺激产生的气道压力分别为MSDLs所产生压力的94.2±3.4%和96.8±5.0%。还评估了其他线状电极配置，但通常效果较差。
这些结果表明，可通过微创技术放置的特定配置的线状电极与盘状电极相比，能产生相当的呼气肌激活效果，可能是恢复SCI患者咳嗽的一种有用技术。
