Neurosurgical Associates of Lancaster, Lancaster, PA, USA.
Abbott Neuromodulation, Plano, TX, USA.
Neuromodulation. 2023 Oct;26(7):1471-1477. doi: 10.1016/j.neurom.2023.01.015. Epub 2023 Mar 3.
Burst spinal cord stimulation (SCS) has shown superior relief from overall pain and a reduction in back and leg pain compared with traditional tonic neurostimulation therapies. However, nearly 80% of patients have two or more noncontiguous pain areas. This can provide challenges in effectively programming stimulation and long-term therapy efficacy. Multiarea DeRidder Burst programming is a new option to treat multisite pain by delivering stimulation to multiple areas along the spinal cord. This study aimed to identify the effect of intraburst frequency, multiarea stimulation, and location of DeRidder Burst on the evoked electromyography (EMG) responses.
Neuromonitoring was performed during permanent implant of SCS leads in nine patients diagnosed with chronic intractable back and/or leg pain. Each patient underwent the surgical placement of a Penta Paddle electrode via laminectomy at the T8-T10 spinal levels. Subdermal electrode needles were placed into lower extremity muscle groups, in addition to the rectus abdominis muscles, for EMG recording. Evoked responses were compared across multiple trials of burst stimulation in which the number of independent burst areas were varied.
The thresholds for EMG recruitment with DeRidder Burst differed across patients owing to anatomic and physiological variations. The average threshold to evoke a bilateral EMG response using single site DeRidder Burst was 3.2 mA. Multisite DeRidder Burst stimulation on up to four stimulation programs evoked a bilateral EMG response at a threshold of 2.5 mA (∼23% lower threshold). DeRidder Burst stimulation across four electrode pairs resulted in more proximal recruitment (vastus medialis and tibialis anterior) than did stimulation across two pairs. It also resulted in more focal coverage of areas across multiple sites.
Across all patients, multisite DeRidder Burst provided broader myotomal coverage than did traditional DeRidder Burst. Multisite DeRidder Burst stimulation provided focal recruitment and differential control of noncontiguous distal myotomes. Energy requirements were also lower when multisite DeRidder Burst was used.
与传统的强直性神经刺激疗法相比，爆发式脊髓刺激（SCS）在缓解整体疼痛以及减轻背部和腿部疼痛方面具有更好的效果。然而，近 80%的患者有两个或更多非连续的疼痛区域。这给有效编程刺激和长期治疗效果带来了挑战。多区域 DeRidder Burst 编程是一种通过向脊髓多个区域提供刺激来治疗多部位疼痛的新选择。本研究旨在确定爆发式脊髓刺激的内爆发频率、多区域刺激和 DeRidder Burst 位置对诱发肌电图（EMG）反应的影响。
在 9 名被诊断为慢性难治性背部和/或腿部疼痛的患者中，永久性植入 SCS 导线时进行神经监测。每位患者均通过椎板切除术在 T8-T10 脊髓水平进行了 Penta Paddle 电极的外科放置。除了腹直肌外，还将皮下电极针放置到下肢肌肉群中，以进行 EMG 记录。通过改变独立爆发区域的数量，比较了多次爆发刺激试验中的爆发响应。
由于解剖和生理变异，DeRidder Burst 诱发 EMG 募集的阈值在患者之间有所不同。使用单部位 DeRidder Burst 诱发双侧 EMG 反应的平均阈值为 3.2mA。在多达四个刺激程序上进行多部位 DeRidder Burst 刺激，可在 2.5mA 的阈值下诱发双侧 EMG 反应（约低 23%的阈值）。与使用两对电极对相比，使用四对电极对进行 DeRidder Burst 刺激会引起更接近近端的募集（股四头肌和胫骨前肌），并且会在多个部位产生更广泛的覆盖范围。
在所有患者中，多部位 DeRidder Burst 提供的肌节覆盖范围比传统的 DeRidder Burst 更广。多部位 DeRidder Burst 刺激提供了焦点募集和非连续远端肌节的差异控制。当使用多部位 DeRidder Burst 时，能量需求也更低。
