Abstract
Introduction
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.
Materials and Methods
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.
Results
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.
Conclusions
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.
Keywords
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Comments
Article info
Publication history
Published online: March 03, 2023
Accepted:
January 23,
2023
Received in revised form:
January 10,
2023
Received:
October 31,
2022
Publication stage
In Press Corrected ProofFootnotes
Source(s) of financial support: This study was funded by Abbott.
Conflict of Interest: Steven M. Falowski is a consultant for Abbott, Medtronic, Saluda, Vertiflex, Boston Scientific, Vertos, Surgentec, Cornerloc, Mainstay, and Relievant and conducts research for Abbott, Medtronic, Saluda, and Nuvectra. He is a minor equity holder for Aurora Spina, Thermaquil, SPR Therapeutics, Saluda, Cornerloc, Painteq, Stimgenics, AGR, Neural Integrative Solutions, Spinethera, and Celeri. Alexander M. Benison and Ameya C. Nanivadekar are employees with Abbott.
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© 2023 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.
