Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, United States.
Nuvasive Clinical Services, San Diego, California, United States.
J Neurophysiol. 2023 Sep 1;130(3):768-774. doi: 10.1152/jn.00221.2023. Epub 2023 Aug 23.
Intraoperative neurophysiological monitoring (IONM) in spinal cord stimulation (SCS) surgery for chronic pain is shown to provide effective guidance during device placement. Electromyography (EMG) is used to determine the laterality of the paddle. In some SCS cases, laterality cannot be obtained via EMG due to patient physiology. Electroencephalography (EEG) is already used in IONM to monitor cortical responses. Here, we show proof-of-concept of assessing the responses of epidurally evoked EMGs simultaneously with EEGs to determine laterality during IONM using a high-resolution (HR) SCS paddle. An 8-column HR-SCS paddle was acutely placed at T9-T10 interspace in patients with failed back surgery syndrome. EMG signals from 18 muscle groups were recorded simultaneously with 60-channel EEG signals at various stimulation amplitudes (0-10 mA). Particular attention was paid to regions associated with pain including the somatosensory cortex (S1), prefrontal cortex (PFC), and motor cortex (M1). When left and right lateral contacts were stimulated at low amplitudes (1-2 mA), significant changes were seen in θ, α, and β powers in the contralateral PFC but not in M1 or S1. There was a significant correlation between M1 and contralateral contacts in α power. At higher currents (7-8 mA), right-sided contacts resulted in α power change. We found significant differences in α, θ, and β powers in PFC for contralateral stimulation of the lateral SCS contacts at low amplitudes and in α power at higher amplitudes. The changes in PFC suggest the potential of EEG for understanding a cortical mechanism of action of SCS and provide insight into the pathophysiology of chronic pain. Here, we present proof of concept of assessing the responses of epidurally evoked electromyography simultaneously with scalp electroencephalography to determine whether both laterality and insights into pain mechanisms can be elucidated. With stimulation, significant changes were seen in θ, α, and β band power in the contralateral prefrontal cortex and in α power in the motor cortex. We provide insight into the mechanism of action of SCS in preventing pain in this patient.
术中神经生理学监测 (IONM) 在脊髓刺激 (SCS) 手术治疗慢性疼痛中被证明可以在设备放置过程中提供有效的指导。肌电图 (EMG) 用于确定桨叶的侧别。在某些 SCS 病例中，由于患者的生理原因，无法通过 EMG 获得侧别。脑电图 (EEG) 已经用于 IONM 以监测皮质反应。在这里，我们展示了使用高分辨率 (HR) SCS 桨叶在 IONM 期间评估硬膜外诱发的 EMG 响应以确定侧别的概念验证，同时记录 60 通道 EEG 信号。在患有失败的背部手术综合征的患者中，将急性放置 8 列 HR-SCS 桨叶在 T9-T10 椎间空间。同时记录来自 18 个肌肉群的 EMG 信号，刺激幅度为 0-10 mA。特别注意与疼痛相关的区域，包括体感皮层 (S1)、前额叶皮层 (PFC) 和运动皮层 (M1)。当在低幅度 (1-2 mA) 刺激左右侧接触时，在对侧 PFC 中观察到θ、α 和β 功率的显著变化，但在 M1 或 S1 中没有观察到。M1 与对侧接触之间存在显著的相关性。在更高的电流 (7-8 mA) 下，右侧接触导致α 功率变化。我们发现，在低幅度刺激时，对侧刺激 SCS 侧接触的 PFC 中α、θ 和β 功率存在显著差异，而在更高幅度时，α 功率存在显著差异。PFC 的变化表明 EEG 具有理解 SCS 作用的皮质机制的潜力，并提供了对慢性疼痛病理生理学的深入了解。在这里，我们提出了评估硬膜外诱发肌电图与头皮脑电图同时响应的概念验证，以确定是否可以阐明侧别和疼痛机制的见解。在刺激时，对侧前额叶皮层中的θ、α 和β 频段功率以及运动皮层中的α 功率发生显著变化。我们提供了有关 SCS 预防疼痛作用机制的见解。
