Acta Neurochirurgica

, Volume 160, Issue 3, pp 639–643 | Cite as

Bipolar dual-lead spinal cord stimulation between two electrodes on the ventral and dorsal sides of the spinal cord: consideration of putative mechanisms

  • Mitsuru Watanabe
  • Takamitsu Yamamoto
  • Chikashi Fukaya
  • Toshiki Obuchi
  • Toshikazu Kano
  • Kazutaka Kobayashi
  • Hideki Oshima
  • Atsuo Yoshino
Case Report - Functional


We have applied bipolar dual-lead spinal cord stimulation (SCS) between two cylinder-type electrodes placed on the ventral and dorsal sides of the spinal cord (dual-VD-SCS). A 36-year-old man suffered from burning pain from his right elbow down to his hand after brachial plexus avulsion. The areas with paresthesia induced by conventional SCS did not include the painful hand area. However, dual-VD-SCS completely induced paresthesia in the painful hand area. We speculate that dual-VD-SCS can be applied to stimulate deeper sites of the dorsal column and dorsal horn than conventional SCS and is useful for pain reduction.


Spinal cord stimulation Neuropathic pain Brachial plexus avulsion Dual-lead SCS 



This work was funded by a Grant-in-Aid for Scientific Research (C-15 K10375) from the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan.

Compliance with ethical standards

Conflict of interest


Ethics approval

This study was approved by the Ethics committee of Nihon University Hospital. Informed consent was obtained from the patient and his family. Additional informed consent was obtained from the patient for whom identifying information is included in this article.


  1. 1.
    Brill S, Aryeh IG (2005) Neuromodulation in the management of pain from brachial plexus injury. Pain Physician 11:81–85Google Scholar
  2. 2.
    Foreman RD, Linderoth B (2012) Neural mechanisms of spinal cord stimulation. Int Rev Neurobiol 107:87–119CrossRefPubMedGoogle Scholar
  3. 3.
    Friedman AH, Nashold BS Jr, Bronec PR (1988) Dorsal root entry zone lesions for the treatment of brachial plexus avulsion injuries: a follow-up study. Neurosurgery 22:365–373Google Scholar
  4. 4.
    Guenot M, Bullier J, Sindou MP (2002) Clinical and electrophysiological expression of deafferentation pain alleviated by dorsal root entry zone lesions in rats. J Neurosurg 97:1402–1409CrossRefPubMedGoogle Scholar
  5. 5.
    Guenot M, Bullier J, Rospars JP, Lansky P, Mertens P, Sindou MP (2003) Single-unit analysis of the spinal dorsal horn in patients with neuropathic pain. J Clin Neurophysiol 20:143–150CrossRefPubMedGoogle Scholar
  6. 6.
    Hemm S, Mennessier G, Vayssiere N, Cif L, Feritt H, Coubes P (2005) Deep brain stimulation in movement disorders: stereotactic coregistration of two-dimensional electrical field modeling and magnetic resonance imaging. J Neurosurg 103:949–955CrossRefPubMedGoogle Scholar
  7. 7.
    Holsheimer J (2002) Which neuronal elements are activated directly by spinal cord stimulation. Neuromodulation 5:25–31CrossRefPubMedGoogle Scholar
  8. 8.
    Larson SJ, Sances A, Cusick JF, Meyer GA, Swiontek T (1975) A comparison between anterior and posterior spinal implant systems. Surg Neurol 4:180–186PubMedGoogle Scholar
  9. 9.
    Lazorthes Y, Verdie JC, Arbus L (1978) Anterior and posterior medullary analgesic stimulation, using a percutaneous implantation technic. Acta Neurochir 40:277–283 (French)CrossRefPubMedGoogle Scholar
  10. 10.
    Piva B, Shaladi A, Saltari R, Gilli G (2003) Spinal cord stimulation in the management of pain from brachial plexus avulsion. Neuromodulation 6:27–31CrossRefPubMedGoogle Scholar
  11. 11.
    Sindou MP, Mertens P, Bendavid U, Garcia-Larrea L, Mauguiere F (2003) Predictive value of somatosensory evoked potentials for long-lasting pain relief after spinal cord stimulation: practical use for patient selection. Neurosurgery 52:1374–1384CrossRefPubMedGoogle Scholar
  12. 12.
    Sindou MP, Blondet E, Emery E, Mertens P (2005) Microsurgical lesioning in the dorsal root entry zone for pain due to brachial plexus avulsion: a prospective series of 55 patients. J Neurosurg 102:1018–1028CrossRefPubMedGoogle Scholar
  13. 13.
    Takai K, Taniguchi M (2017) Modified dorsal root entry zone lesioning for intractable pain relief in patients with root avulsion injury. J Neurosurg Spine 27:178–184CrossRefPubMedGoogle Scholar
  14. 14.
    The British Pain Society (2009) Spinal cord stimulation for the management of pain: recommendations for best clinical practice. The British Pain Society, LondonGoogle Scholar
  15. 15.
    Yamamoto T, Katayama Y, Fukaya C, Oshima H, Kasai M, Kobayashi K (2001) New method of deep brain stimulation therapy with two electrodes implanted in parallel and side by side. J Neurosurg 95:1075–1078CrossRefPubMedGoogle Scholar
  16. 16.
    Yamamoto T, Watanabe M, Obuchi T, Kano T, Kobayashi K, Oshima H, Fukaya C, Yoshino A (2016) Importance of pharmacological evaluation in the treatment of post stroke pain by spinal cord stimulation. Neuromodulation 19:744–751CrossRefPubMedGoogle Scholar
  17. 17.
    Zhang TC, Janik JJ, Grill WM (2014) Mechanisms and models of spinal cord stimulation for the treatment of neuropathic pain. Brain Res 1569:19–31CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2017

Authors and Affiliations

  • Mitsuru Watanabe
    • 1
  • Takamitsu Yamamoto
    • 1
  • Chikashi Fukaya
    • 1
  • Toshiki Obuchi
    • 1
  • Toshikazu Kano
    • 1
  • Kazutaka Kobayashi
    • 1
  • Hideki Oshima
    • 1
  • Atsuo Yoshino
    • 1
  1. 1.Department of Neurological SurgeryNihon University School of MedicineTokyoJapan

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