Falowski Steven M, Benison Alexander
Neurosurgical Associates of Lancaster, Lancaster, PA, USA.
J Pain Res. 2021 Mar 11;14:703-710. doi: 10.2147/JPR.S298797. eCollection 2021.
Intraoperative neuromonitoring (IONM) for spinal cord stimulation (SCS) uses electromyography (EMG) responses to determine myotomal coverage as a marker for dermatomal coverage.
These responses can be utilized to evaluate the effects of stimulation platforms on the nervous system.
Eight patients were tested at inter-burst frequencies of 10 Hz, 20 Hz, 30 Hz, and 40 Hz using DeRidder Burst stimulation to determine the amplitude of onset of post-synaptic signal generation. Three patients had additional data recording amplitude of onset of tonic stimulation prior to and post DeRidder Burst stimulation at each inter-burst frequency. This represented post-synaptic excitability.
In all patients, the DeRidder Burst waveform generated EMG responses under all inter-burst frequencies including temporal summation, deeper fiber recruitment, and compounded action potentials. There was a non-significant decrease of 7.6-7.8% in amplitudes to generate response under 40 Hz, compared to the other frequencies. However, there was a 73.1% reduction in energy requirements at 10 Hz. The enhanced post-synaptic excitability effect was demonstrated at all frequencies.
DeRidder Burst has similar effects of temporal summation, deeper fiber recruitment, and compounded action potentials under IONM at 40 Hz, 30 Hz, 20 Hz, and 10 Hz. In addition, the hyperexcitability phenomenon was also observed regardless of the frequency. This demonstrates that postsynaptic responses captured via IONM may be a sensitive biomarker to SCS mechanism of action. In addition, lower inter-burst frequencies may have a similar clinical effect on pain relief thus reducing power consumption even further than current dosing paradigms.
脊髓刺激术（SCS）的术中神经监测（IONM）利用肌电图（EMG）反应来确定肌节覆盖范围，以此作为皮节覆盖范围的指标。
这些反应可用于评估刺激平台对神经系统的影响。
使用德里德猝发刺激，以10Hz、20Hz、30Hz和40Hz的猝发间隔频率对8名患者进行测试，以确定突触后信号产生起始的幅度。3名患者在每个猝发间隔频率的德里德猝发刺激之前和之后，还记录了强直刺激起始的幅度数据。这代表了突触后兴奋性。
在所有患者中，德里德猝发波形在所有猝发间隔频率下均产生了EMG反应，包括时间总和、更深层纤维募集和复合动作电位。与其他频率相比，在40Hz下产生反应的幅度有7.6 - 7.8%的非显著性下降。然而，在10Hz时能量需求降低了73.1%。在所有频率下均显示出增强的突触后兴奋性效应。
在40Hz、30Hz、20Hz和10Hz的IONM下，德里德猝发具有类似的时间总和、更深层纤维募集和复合动作电位的效应。此外，无论频率如何，均观察到了兴奋性过高现象。这表明通过IONM捕获的突触后反应可能是SCS作用机制的敏感生物标志物。此外，较低的猝发间隔频率可能对疼痛缓解具有类似的临床效果，从而比当前的给药模式进一步降低功耗。
