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High-Frequency Spinal Cord Stimulation for the Treatment of Chronic Low Back and Leg Pain: Implantation Technique of Percutaneous Leads and Implantable Pulse Generator.

ABSTRACT: Spinal cord stimulation (SCS) is an evidence-based, reversible but invasive procedure for the treatment of chronic pain syndromes: for example, in patients with failed-back-surgery syndrome or complex regional pain syndrome. A more recent, similar technique uses high-frequency stimulation for SCS and follows a different mechanism of action that does not result in paresthesia. This Technical Note and video present surgical instructions of a "2-way cut-down" technique for a high-frequency SCS trial period and permanent implantation of an implantable pulse generator.

SUBMITTER: Kasapovic A

PROVIDER: S-EPMC6948134 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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High-Frequency Spinal Cord Stimulation for the Treatment of Chronic Low Back and Leg Pain: Implantation Technique of Percutaneous Leads and Implantable Pulse Generator.

Kasapovic Adnan A Rommelspacher Yorck Y Gathen Martin M Cucchi Davide D Bornemann Rahel R Pflugmacher Robert R Walter Sebastian G SG

Arthroscopy techniques 20190919 10

Spinal cord stimulation (SCS) is an evidence-based, reversible but invasive procedure for the treatment of chronic pain syndromes: for example, in patients with failed-back-surgery syndrome or complex regional pain syndrome. A more recent, similar technique uses high-frequency stimulation for SCS and follows a different mechanism of action that does not result in paresthesia. This Technical Note and video present surgical instructions of a "2-way cut-down" technique for a high-frequency SCS tria ...[more]

PMID: 31921585

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Project description:ObjectivesThis article presents a method-including hardware configuration, sampling rate, filtering settings, and other data analysis techniques-to measure evoked compound action potentials (ECAPs) during spinal cord stimulation (SCS) in humans with externalized percutaneous electrodes. The goal is to provide a robust and standardized protocol for measuring ECAPs on the non-stimulation contacts and to demonstrate how measured signals depend on hardware and processing decisions.MethodsTwo participants were implanted with percutaneous leads for the treatment of chronic pain with externalized leads during a trial period for stimulation and recording. The leads were connected to a Neuralynx ATLAS system allowing us to simultaneously stimulate and record through selected electrodes. We examined different hardware settings, such as online filters and sampling rate, as well as processing techniques, such as stimulation artifact removal and offline filters, and measured the effects on the ECAPs metrics: the first negative peak (N1) time and peak-valley amplitude.ResultsFor accurate measurements of ECAPs, the hardware sampling rate should be least at 8 kHz and should use a high pass filter with a low cutoff frequency, such as 0.1 Hz, to eliminate baseline drift and saturation (railing). Stimulation artifact removal can use a double exponential or a second-order polynomial. The polynomial fit is 6.4 times faster on average in computation time than the double exponential, while the resulting ECAPs' N1 time and peak-valley amplitude are similar between the two. If the baseline raw measurement drifts with stimulation, a median filter with a 100-ms window or a high pass filter with an 80-Hz cutoff frequency preserves the ECAPs.ConclusionsThis work is the first comprehensive analysis of hardware and processing variations on the observed ECAPs from SCS leads. It sets recommendations to properly record and process ECAPs from the non-stimulation contacts on the implantable leads.

Dataset Information

High-Frequency Spinal Cord Stimulation for the Treatment of Chronic Low Back and Leg Pain: Implantation Technique of Percutaneous Leads and Implantable Pulse Generator.

Publications

High-Frequency Spinal Cord Stimulation for the Treatment of Chronic Low Back and Leg Pain: Implantation Technique of Percutaneous Leads and Implantable Pulse Generator.

Similar Datasets

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