Dorsal column stimulation in man: facilitation of primary afferent depolarization.

The effects of cervical epidural dorsal column stimulation on the negative and slow positive waves of the spinal cord potentials recorded from the posterior epidural space at the lumbar enlargement, in response to intense stimulation of the tibial nerve in five neurologically normal subjects during neuroleptanesthesia were studied. Single pulses applied to the cervical dorsal cord near the midline produced slow positive potentials preceded by negative waves in the dorsal spinal cord at the level of the lumbar enlargement. The negative wave, believed to represent synchronized activities of interneurons, was inhibited up to 100 to 120 msec by conditioning dorsal column stimulation. The slow positive wave, though to represent primary afferent depolarization, was facilitated for more than 100 msec with transient inhibitor for 10 to 40 msec. The results suggest that the pain-alleviating effect of dorsal column stimulation in man may be at least partly due to orthodromic and/or antidromic activation of descending inhibitory pathways which inhibit the responsible cells and facilitate primary afferent depolarization.