• Neurosurgery · Sep 2022

    High-Resolution Spinal Motor Mapping Using Thoracic Spinal Cord Stimulation in Patients With Chronic Pain.

    • Ilknur Telkes, Amir Hadanny, Marisa DiMarzio, Girish Chitnis, Steven Paniccioli, Katherine O'Connor, Rachael Grey, Kevin McCarthy, Olga Khazen, Bryan McLaughlin, and Julie G Pilitsis.
    • Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA.
    • Neurosurgery. 2022 Sep 1; 91 (3): 459469459-469.

    BackgroundHigh-resolution spinal cord stimulation (HR-SCS) paddle can stimulate medial-dorsal columns and extend stimulation coverage to the laterally positioned spinal targets.ObjectiveTo investigate the medio-lateral selectivity of an HR-SCS paddle in patients with chronic pain.MethodsDuring standard-of-care spinal cord stimulation (SCS) placement, epidurally evoked electromyography and antidromic dorsal column-evoked potentials were recorded in 12 subjects using an HR-SCS paddle with 8 medio-lateral sites spanning the full epidural width at thoracic T9-12 and a commercial paddle consecutively.ResultsRecruitment maps were aligned with respect to physiological midline which was overlapping with anatomic midline in 10 of 11 cases. Overlapping contacts between the HR-SCS and commercial paddles exhibited similar patterns while HR-SCS demonstrated higher precision targeting of certain dermatomes. Spinal motor maps showed that the lateral contacts triggered stronger responses in medial gastrocnemius, adductor magnus, and tibialis anterior while the medial contacts triggered stronger responses in gluteus maximus and adductor hallucis. The time-locked popliteal fossa responses indicated ipsilateral activation by HR-SCS at the lateral contacts and bilateral activation at the medial contacts with stronger ipsilateral responses.ConclusionThis study is the first to perform high-resolution medio-lateral SCS mapping in patients with chronic pain. These results show promise that HR-SCS may provide additional ipsilateral recruitment within the extremities which improve targeting of focal pain in the lower extremities. Furthermore, this study supports the functional use of intraoperative neuromonitoring as a decision tool to determine physiological midline in thoracic SCS surgeries and provides a full methodological framework.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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