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Spinal Cord Stimulation: Engineering Approaches to Clinical and Physiological Challenges

  • Michael A. Moffitt
  • Dongchul C. Lee
  • Kerry Bradley
Chapter
First Online:
Part of the Biological and Medical Physics, Biomedical Engineering book series (BIOMEDICAL)

Abstract

Spinal cord stimulation is an effective therapy for the management of chronic pain with historical origins dating back to the 1960s. The therapy consists of electrical stimulation of the spinal cord to ‘mask’ pain. One effect of stimulation is generation of tingling paresthesia in the patient, and overlap of the paresthesia with the pain is important to successful therapy. Clinical and anatomical challenges to successful and durable concordant paresthesia include: contact impedance changes, lead migration, clinical programming time requirements, unknown anatomic variables, and optimal lead design. In this chapter we review these challenges, the principles guiding engineering solutions and trade-offs, and the use of computational tools to guide design of system components. Topics include a historical overview, stimulation waveform and clinical effects of waveform parameters such as pulse width, voltage vs. current control, multiple-source systems, real-time programming methods, contact size and spacing, use of field potentials for electrical imaging, modeling methods, and others.

Keywords

Spinal Cord Stimulation Dorsal Column Contact Impedance Timing Channel Implantable Pulse Generator 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References

  1. 1.
    Melzack, R. and P.D. Wall, Pain mechanisms: a new theory. Science, 1965, 150(699): 971–9.CrossRefGoogle Scholar
  2. 2.
    Linderoth, B. and R. Foreman, Physiology of spinal cord stimulation: review and update. Neuromodulation, 1999, 2(3): 150–64.CrossRefGoogle Scholar
  3. 3.
    Taub, A. and L.M. Kitahata, Modulation of spinal-cord function by anesthesia. Anesthesiology, 1975, 43(4): 383–5.CrossRefGoogle Scholar
  4. 4.
    Bennett, D. and D. Brookoff, Complex regional pain syndromes (reflex sympathetic dystrophy and causalgia) and spinal cord stimulation. Pain Med, 2006, 7(S1): S64–S96.CrossRefGoogle Scholar
  5. 5.
    Melzack, R., Evolution of the neuromatrix theory of pain. The Prithvi Raj Lecture: presented at the third World Congress of World Institute of Pain, Barcelona 2004. Pain Pract, 2005, 5(2): 85–94.CrossRefGoogle Scholar
  6. 6.
    Shealy, C.N., J.T. Mortimer, and J.B. Reswick, Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg, 1967, 46(4): 489–91.CrossRefGoogle Scholar
  7. 7.
    Brest, A.N., L. Wiener, and B. Bachrach, Bilateral carotid sinus nerve stimulation in the treatment of hypertension. Am J Cardiol, 1972, 29(6): 821–5.CrossRefGoogle Scholar
  8. 8.
    Burton, C., Dorsal column stimulation: optimization of application. Surg Neurol, 1975, 4(1): 171–9.Google Scholar
  9. 9.
    Cameron, T., Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: a 20-year literature review. J Neurosurg, 2004, 100(3 Suppl Spine): 254–67.Google Scholar
  10. 10.
    Kumar, K., R. Nath, and G.M. Wyant, Treatment of chronic pain by epidural spinal cord stimulation: a 10-year experience. J Neurosurg, 1991, 75(3): 402–7.CrossRefGoogle Scholar
  11. 11.
    North, R.B., et al., A prospective, randomized study of spinal cord stimulation versus reoperation for failed back surgery syndrome: initial results. Stereotact Funct Neurosurg, 1994, 62(1–4): 267–72.CrossRefGoogle Scholar
  12. 12.
    Siegfried, J. and Y. Lazorthes, Long-term follow-up of dorsal cord stimulation for chronic pain syndrome after multiple lumbar operations. Appl Neurophysiol, 1982, 45(1–2): 201–4.Google Scholar
  13. 13.
    Barolat, G., Spinal cord stimulation for chronic pain management. Arch Med Res, 2000, 31(3): 258–62.CrossRefGoogle Scholar
  14. 14.
    Barolat, G., Current status of epidural spinal cord stimulation. Neurosurg Q, 1995, 5(2): 98–124.CrossRefGoogle Scholar
  15. 15.
    North, R.B., et al., Spinal cord stimulation for chronic, intractable pain: superiority of “multi-channel” devices. Pain, 1991, 44(2): 119–30.CrossRefGoogle Scholar
  16. 16.
    North, R.B., et al., Spinal cord stimulation for chronic, intractable pain: experience over two decades. Neurosurgery, 1993, 32(3): 384–94; discussion 394–5.CrossRefGoogle Scholar
  17. 17.
    Hornberger, J., et al., Rechargeable spinal cord stimulation versus non-rechargeable system for patients with failed back surgery syndrome: a cost-consequences analysis. Clin J Pain, 2008, 24(3): 244–52.CrossRefGoogle Scholar
  18. 18.
    Oakley, J.C. and J.P. Prager, Spinal cord stimulation: mechanisms of action. Spine, 2002, 27(22): 2574–83.CrossRefGoogle Scholar
  19. 19.
    Holsheimer, J., et al., Significance of the spinal cord position in spinal cord stimulation. Acta Neurochir Suppl, 1995, 64: 119–24.CrossRefGoogle Scholar
  20. 20.
    Kandell, E., J. Schwartz, and T. Jessell, Principles of Neural Science. 4th ed. 2000, New York: McGraw-Hill, Health Professions Division.Google Scholar
  21. 21.
    Oakley, J.C., C. Varga, and E. Krames, Bradley K., Real-time paresthesia steering using continuous electric field adjustment. Part I: intraoperative performance. Neuromodulation, 2004, 7(3): 157–67.CrossRefGoogle Scholar
  22. 22.
    Hosobuchi, Y., J.E. Adams, and P.R. Weinstein, Preliminary percutaneous dorsal column stimulation prior to permanent implantation. Technical note. J Neurosurg, 1972, 37(2): 242–5.CrossRefGoogle Scholar
  23. 23.
    Olin, J.K., D.H. Kidd, and R.B. North,, Postural changes in spinal cord stimulation thresholds. Neuromodulation, 1998, 1(4): 171–5.CrossRefGoogle Scholar
  24. 24.
    Dijkstra, E.A., J. Holsheimer, W. Olthuis, and P. Bergveld, Ultrasonic distance detection for a closed-loop spinal cord stimulation system. Engineering in Medicine and Biology Society. Proceedings of the 19th Annual International Conference of the IEEE, 1997, 5: 1954–7.Google Scholar
  25. 25.
    Barolat, G. and A.D. Sharan, Future trends in spinal cord stimulation. Neurol Res, 2000, 22(3): 279–84.Google Scholar
  26. 26.
    North, R.B., et al., Automated, patient-interactive, spinal cord stimulator adjustment: a randomized controlled trial. Neurosurgery, 2003, 52(3): 572–80; discussion 579–80.CrossRefGoogle Scholar
  27. 27.
    Grill, W.M. and J.T. Mortimer, Electrical properties of implant encapsulation tissue. Ann Biomed Eng, 1994, 22(1): 23–33.CrossRefGoogle Scholar
  28. 28.
    Oakley, J.C., J. Prager, E. Krames, R. Weiner, J. Stamatos, and K. Bradley, Variability of Contact Impedance Over Time in SCS. in American Society Stereotactic and Functional Neurosurgery Biennial Meeting. 2004. Cleveland, OH: Stereotactic and Functional Neurosurgery.Google Scholar
  29. 29.
    Struijk, J.J., J. Holsheimer, and H.B. Boom, Excitation of dorsal root fibers in spinal cord stimulation: a theoretical study. IEEE Trans Biomed Eng, 1993, 40(7): 632–9.CrossRefGoogle Scholar
  30. 30.
    Vistnes, L.M., G.A. Ksander, and J. Kosek, Study of encapsulation of silicone rubber implants in animals. A foreign-body reaction. Plast Reconstr Surg, 1978, 62(4): 580–8.CrossRefGoogle Scholar
  31. 31.
    Holsheimer, J. and L. Manola, Neuromodulation in epilepsy and chronic pain. Neuromodulation, 2004, 9(2): 143–53.Google Scholar
  32. 32.
    Holsheimer, J. and W.A. Wesselink, Effect of anode-cathode configuration on paresthesia coverage in spinal cord stimulation. Neurosurgery, 1997, 41(3): 654–9; discussion 659–60.Google Scholar
  33. 33.
    Law, J., Targeting a spinal stimulator to treat the ‘failed back surgery syndrome’. Appl Neurophysiol, 1987, 50: 437–8.Google Scholar
  34. 34.
    Holsheimer, J. and J.J. Struijk, Electrode Geometry and Preferential Stimulation of Spinal Nerve Figers Having Different Orientations: A Modeling Study. in 14th Ann Int Conf IEEE Eng in Med & Biol Soc, 1992, Paris, France.Google Scholar
  35. 35.
    Holsheimer, J., J.J. Struijk, and N.R. Tas, Effects of electrode geometry and combination on nerve fibre selectivity in spinal cord stimulation. Med Biol Eng Comput, 1995, 33(5): 676–82.CrossRefGoogle Scholar
  36. 36.
    Ranck, J.B., Jr., Which elements are excited in electrical stimulation of mammalian central nervous system: a review. Brain Res, 1975, 98(3): 417–40.CrossRefGoogle Scholar
  37. 37.
    McNeal, D.R., Analysis of a model for excitation of myelinated nerve. IEEE Trans Biomed Eng, 1976, 23(4): 329–37.CrossRefGoogle Scholar
  38. 38.
    Rattay, F., Analysis of models for external stimulation of axons. IEEE Trans Biomed Eng, 1986, 33(10): 974–7.CrossRefGoogle Scholar
  39. 39.
    Moffitt, M.A., C.C. McIntyre, and W.M. Grill, Prediction of myelinated nerve fiber stimulation thresholds: limitations of linear models. IEEE Trans Biomed Eng, 2004, 51(2): 229–36.CrossRefGoogle Scholar
  40. 40.
    Warman, E.N., W.M. Grill, and D. Durand, Modeling the effects of electric fields on nerve fibers: determination of excitation thresholds. IEEE Trans Biomed Eng, 1992, 39(12): 1244–54.CrossRefGoogle Scholar
  41. 41.
    Holsheimer, J. and G. Barolat, Spinal geometry and paresthesia coverage in spinal cord stimulation. Neuromodulation, 1998, 1(3): 129–36.CrossRefGoogle Scholar
  42. 42.
    Holsheimer, J., et al., MR assessment of the normal position of the spinal cord in the spinal canal. AJNR Am J Neuroradiol, 1994, 15(5): 951–9.Google Scholar
  43. 43.
    Holsheimer, J. and W.A. Wesselink, Optimum electrode geometry for spinal cord stimulation: the narrow bipole and tripole. Med Biol Eng Comput, 1997, 35(5): 493–7.CrossRefGoogle Scholar
  44. 44.
    Manola, L., J. Holsheimer, and P. Veltink, Technical performance of percutaneous leads for spinal cord stimulation: a modeling study. Neuromodulation, 2005, 8(2): 88–99.CrossRefGoogle Scholar
  45. 45.
    Cameron, T. and K. Alo, Effects of posture on stimulation parameters in spinal cord stimulation. Neuromodulation, 1998, 1(4): 177–83.CrossRefGoogle Scholar
  46. 46.
    Moro, E., et al., Subthalamic nucleus stimulation: improvements in outcome with reprogramming. Arch Neurol, 2006, 63(9): 1266–72.CrossRefGoogle Scholar
  47. 47.
    Gorman, P.H. and J.T. Mortimer, The effect of stimulus parameters on the recruitment characteristics of direct nerve stimulation. IEEE Trans Biomed Eng, 1983, 30(7): 407–14.CrossRefGoogle Scholar
  48. 48.
    van den Honert, C. and J.T. Mortimer, The response of the myelinated nerve fiber to short duration biphasic stimulating currents. Ann Biomed Eng, 1979, 7(2): 117–25.CrossRefGoogle Scholar
  49. 49.
    McIntyre, C.C. and W.M. Grill, Selective microstimulation of central nervous system neurons. Ann Biomed Eng, 2000, 28(3): 219–33.CrossRefGoogle Scholar
  50. 50.
    McIntyre, C.C. and W.M. Grill, Extracellular stimulation of central neurons: influence of stimulus waveform and frequency on neuronal output. J Neurophysiol, 2002, 88(4): 1592–604.Google Scholar
  51. 51.
    Grill, W.M. and J.T. Mortimer, Stimulus waveforms for selective neural stimulation, in Engineering in Medicine and Biology Magazine, IEEE, 1995, 375–85.Google Scholar
  52. 52.
    Grill, W.M. and J.T. Mortimer, Inversion of the current-distance relationship by transient depolarization. IEEE Trans Biomed Eng, 1997, 44(1): 1–9.CrossRefGoogle Scholar
  53. 53.
    Merrill, D.R., M. Bikson, and J.G. Jefferys, Electrical stimulation of excitable tissue: design of efficacious and safe protocols. J Neurosci Methods, 2005, 141(2): 171–98.CrossRefGoogle Scholar
  54. 54.
    Alo, K., Patient-reported differences in constant current and constant voltage stimulation, in 11th North American Neuromodulation Society, 2007: Acapulco, Mexico.Google Scholar
  55. 55.
    Alo, K. and T. Cartwright, Patient preferences for constant current and constant voltage stimulation, in 11th North American Neuromodulation Society, 2007: Acapulco, Mexico.Google Scholar
  56. 56.
    Mortimer, J.T., Motor prostheses, Chapter 5, in Handbook of Physiology – The Nervous System III, V. Brooks, Editor, 1981, American Physiological Society: Bethesda, Maryland. pp. 155–87.Google Scholar
  57. 57.
    Ranck, J.B., Jr., Extracellular stimulation, in Electrical Stimulation Research Techniques: Methods in Physiological Psychology III, Patterson, M.M. and R.P. Kesner, (ed). 1981, New York: Academic Press, pp. 1–36.Google Scholar
  58. 58.
    Scheiner, A., J.T. Mortimer, and U. Roessmann, Imbalanced biphasic electrical stimulation: muscle tissue damage. Ann Biomed Eng, 1990, 18(4): 407–25.CrossRefGoogle Scholar
  59. 59.
    Andersen, C., Time dependent variation of stimulus requirements in spinal cord stimulation for angina pectoris. Pacing Clin Electrophysiol, 1997, 20(2 Pt 1): 359–63.CrossRefGoogle Scholar
  60. 60.
    Spangenberg, P., Time-dependent variation of stimulus requirements of single SCS (spinal cord stimulation) leads with respect to pain relief, in 54th Annual Meeting of the German Society of Neurosurgery. 2003: Saarbrucken, Germany, MO 18–03.Google Scholar
  61. 61.
    Kumar, K., G. Hunter, and D. Demeria, Spinal cord stimulation in treatment of chronic benign pain: challenges in treatment planning and present status, a 22-year experience. Neurosurgery, 2006, 58(3): 481–96; discussion 481–96.Google Scholar
  62. 62.
    Oakley, J.C., et al., Transverse tripolar spinal cord stimulation: results of an international multicenter study. Neuromodulation, 2006, 9(3):192–203.Google Scholar
  63. 63.
    Wesselink, W.A., et al., Quantitative aspects of the clinical performance of transverse tripolar spinal cord stimulation. Neuromodulation, 1999, 2(1): 5–14.CrossRefGoogle Scholar
  64. 64.
    Slavin, K.V., et al., Efficacy of transverse tripolar stimulation for relief of chronic low back pain: results of a single center. Stereotact Funct Neurosurg, 1999, 73(1–4): 126–30.CrossRefGoogle Scholar
  65. 65.
    Veraart, C., W.M. Grill, and J.T. Mortimer, Selective control of muscle activation with a multipolar nerve cuff electrode. IEEE Trans Biomed Eng, 1993, 40(7): 640–53.CrossRefGoogle Scholar
  66. 66.
    Struijk, J.J. and J. Holsheimer, Transverse tripolar spinal cord stimulation: theoretical performance of a dual channel system. Med Biol Eng Comput, 1996, 34(4): 273–9.CrossRefGoogle Scholar
  67. 67.
    Racz, G.B., R.F. McCarron, and P. Talboys, Percutaneous dorsal column stimulator for chronic pain control. Spine, 1989, 14(1): 1–4.CrossRefGoogle Scholar
  68. 68.
    Renard, V.M. and R.B. North, Prevention of percutaneous electrode migration in spinal cord stimulation by a modification of the standard implantation technique. J Neurosurg Spine, 2006, 4(4): 300–3.CrossRefGoogle Scholar
  69. 69.
    Rosenow, J.M., et al., Failure modes of spinal cord stimulation hardware. J Neurosurg Spine, 2006, 5(3): 183–90.CrossRefGoogle Scholar
  70. 70.
    Plonsey, R. and R.C. Barr, Electric field stimulation of excitable tissue. IEEE Trans Biomed Eng, 1995, 42(4): 329–36.CrossRefGoogle Scholar
  71. 71.
    Kosek, P., D. Morgan, J. Dunn, J. Oakley, R. Rosenthal, M. Moffitt, V. Grandhe, and K. Bradley, Electronically Generated Lead (EGL) Scan: Report of First Clinical Use, in 11th Annual North American Neuromodulation Society, 2006, Las Vegas, NV.Google Scholar
  72. 72.
    Davis, R. and E. Gray, Technical factors important to dorsal column stimulation. Appl Neurophysiol, 1981, 44(1–3): 160–70.Google Scholar
  73. 73.
    Hoppenstein, R., Electrical stimulation of the ventral and dorsal columns of the spinal cord for relief of chronic intractable pain: preliminary report. Surg Neurol, 1975, 4(1): 187–94.Google Scholar
  74. 74.
    Law, J., Spinal stimulation: statistical superiority of monophasic stimulation of narrowly separated, longitudinal bipoles having rostral cathodes. Appl Neurophysiol, 1983, 46: 129–37.Google Scholar
  75. 75.
    Law, J.D. and L.V. Miller, Importance and documentation of an epidural stimulating position. Appl Neurophysiol, 1982, 45: 461–4.Google Scholar
  76. 76.
    North, R.B., et al., Patient-interactive, computer-controlled neurological stimulation system: clinical efficacy in spinal cord stimulator adjustment. J Neurosurg, 1992, 76(6): 967–72.CrossRefGoogle Scholar
  77. 77.
    Alo, K., V. Redko, and J. Charnov, Four year follow-up of dual electrode spinal cord stimulation for chronic pain. Neuromodulation, 2002, 5(2): 79–88.CrossRefGoogle Scholar
  78. 78.
    Alo, K., Spinal cord stimulation for complex pain: initial experience with a dual electrode, programmable, internal pulse generator. Pain Practice, 2003, 3(1): 31–38.CrossRefGoogle Scholar
  79. 79.
    Holsheimer, J., J.J. Struijk, and N.J. Rijkhoff, Contact combinations in epidural spinal cord stimulation. A comparison by computer modeling. Stereotact Funct Neurosurg, 1991, 56(4): 220–33.CrossRefGoogle Scholar
  80. 80.
    Holsheimer, J. and L. Manola, Technical Performance of Percutaneous SCS Leads, in 6th World Congress of the International Neuromodulation Society, 2003, Madrid, Spain.Google Scholar
  81. 81.
    Barolat, G., S. Zeme, and B. Ketcik, Multifactorial analysis of epidural spinal cord stimulation. Stereotact Funct Neurosurg, 1991, 56(2): 77–103.CrossRefGoogle Scholar
  82. 82.
    Alo, K., M.J. Yland, D.L. Kramer, J.H. Charnov, and V. Redko, Computer assisted and patient interactive programming of dual octrode spinal cord stimulation in the treatment of chronic pain. Neuromodulation, 1998, 1(1): 30–45.CrossRefGoogle Scholar
  83. 83.
    Oakley, J.C., Spinal cord stimulation: patient selection, technique, and outcomes. Neurosurg Clin N Am, 2003, 14(3): 365–80, vi.CrossRefGoogle Scholar
  84. 84.
    North, R.B., Spinal cord stimulation with interleaved pulses: a randomized, controlled trial. Neuromodulation, 2007, 10(4): 349–57.CrossRefGoogle Scholar
  85. 85.
    Jobling, D.T., et al., Electronic aspects of spinal-cord stimulation in multiple sclerosis. Med Biol Eng Comput, 1980, 18(1): 48–56.CrossRefGoogle Scholar
  86. 86.
    Lapicque, L., On electric stimulation of muscle through ringer’s solution. J Physiol, 1931, 73(3): 219–46.Google Scholar
  87. 87.
    Geddes, L.A. and J.D. Bourland, The strength-duration curve. IEEE Trans Biomed Eng, 1985, 32(6): 458–9.CrossRefGoogle Scholar
  88. 88.
    Irnich, W., The chronaxie time and its practical importance. Pacing Clin Electrophysiol, 1980, 3(3): 292–301.CrossRefGoogle Scholar
  89. 89.
    Geddes, L.A., Accuracy limitations of chronaxie values. IEEE Trans Biomed Eng, 2004, 51(1): 176–81.CrossRefGoogle Scholar
  90. 90.
    Miocinovic, S. and W.M. Grill, Sensitivity of temporal excitation properties to the neuronal element activated by extracellular stimulation. J Neurosci Methods, 2004, 132(1): 91–9.CrossRefGoogle Scholar
  91. 91.
    Holsheimer, J., et al., Chronaxie calculated from current-duration and voltage-duration data. J Neurosci Methods, 2000, 97(1): 45–50.CrossRefGoogle Scholar
  92. 92.
    Yearwood, T.B. Hershey, D.C. Lee, and K. Bradley, Pulse width Programming in Spinal Cord Stimulation: A Clinical Study Pain Medicine 2009 (In press).Google Scholar
  93. 93.
    Lee, D.C.B. Hershey, K. Bradley, M. Moffitt, D, Peterson, Yearwood, TL, Dorsal Column Selectivity in Pulse Width (PW) Programming of Spinal Cord Stimulation (SCS): Computational model for the Sacral Shift, in 11th Annual North American Neuromodulation Society Meeting, 2007, Acapulco, Mexico.Google Scholar
  94. 94.
    Feirabend, H.K., et al., Morphometry of human superficial dorsal and dorsolateral column fibres: significance to spinal cord stimulation. Brain, 2002, 125(Pt 5): 1137–49.CrossRefGoogle Scholar
  95. 95.
    Campbell, J.N. and D.M. Long, Peripheral nerve stimulation in the treatment of intractable pain. J Neurosurg, 1976, 45(6): 692–9.CrossRefGoogle Scholar
  96. 96.
    Ignelzi, R.J., J.K. Nyquist, and W.J. Tighe, Jr., Repetitive electrical stimulation of peripheral nerve and spinal cord activity. Neurol Res, 1981, 3(2): 195–209.Google Scholar
  97. 97.
    Krauthamer, V., Modulation of conduction at points of axonal bifurcation by applied electric fields. IEEE Trans Biomed Eng, 1990, 37(5): 515–9.CrossRefGoogle Scholar
  98. 98.
    Bennett, D., K.M. Aló, J, Oakley, and C. Feler,, Spinal cord stimulation for complex regional pain syndrome i [RSD]: a retrospective multicenter experience from 1995–1998 of 101 Patients. Neuromodulation, 1999, 2(3): 202–10.CrossRefGoogle Scholar
  99. 99.
    Waltz, J., Spinal cord stimulation: a quarter century of development and investigation. Stereotact Funct Neurosurg, 1997, 69: 288–99.CrossRefGoogle Scholar
  100. 100.
    Schneider, S.P., Mechanosensory afferent input and neuronal firing properties in rodent spinal laminae III-V: re-examination of relationships with analysis of responses to static and time-varying stimuli. Brain Res, 2005, 1034(1–2): 71–89.CrossRefGoogle Scholar
  101. 101.
    Coburn, B., Electrical stimulation of the spinal cord: two-dimensional finite element analysis with particular reference to epidural electrodes. Med Biol Eng Comput, 1980, 18(5): 573–84.CrossRefGoogle Scholar
  102. 102.
    Holsheimer, J. and J.J. Struijk, Analysis of spinal cord stimulation. I. Field potentials calculated for a homogeneous medium, in Electrophysiological Kinesiology, Wallinga, W., H.B. Boom, and J. de Vries, (eds.), 1988, Excerpta Medica Congress Series: Amsterdam, pp. 95–8.Google Scholar
  103. 103.
    Frankenhaeuser, B. and A.F. Huxley, The action potential in the myelinated nerve fiber of xenopus laevis as computed on the basis of voltage clamp data. J Physiol, 1964, 171: 302–15.Google Scholar
  104. 104.
    Struijk, J.J., et al., Epidural spinal cord stimulation: calculation of field potentials with special reference to dorsal column nerve fibers. IEEE Trans Biomed Eng, 1991, 38(1): 104–10.CrossRefGoogle Scholar
  105. 105.
    Struijk, J.J., et al., Recruitment of dorsal column fibers in spinal cord stimulation: influence of collateral branching. IEEE Trans Biomed Eng, 1992, 39(9): 903–12.CrossRefGoogle Scholar
  106. 106.
    Struijk, J.J., et al., Paresthesia thresholds in spinal cord stimulation: a comparison of theoretical results with clinical data. IEEE Trans Rehab Eng, 1993, 1(2): 101–7.CrossRefGoogle Scholar
  107. 107.
    He, J., et al., Perception threshold and electrode position for spinal cord stimulation. Pain, 1994, 59(1): 55–63.CrossRefGoogle Scholar
  108. 108.
    Goodall, E., M. Kosternman, and J. Holsheimer, Modeling study of activation and propagation delays during stimulation of peripheral nerve fibers with a tripolar cuff electrode. IEEE Trans Rehabil Eng, 1995, 3(3): 272–82.CrossRefGoogle Scholar
  109. 109.
    Wesselink, W.A., J. Holsheimer, and H.B. Boom, A model of the electrical behaviour of myelinated sensory nerve fibres based on human data. Med Biol Eng Comput, 1999, 37(2): 228–35.CrossRefGoogle Scholar
  110. 110.
    Wesselink, W.A., et al., Estimation of fiber diameters in the spinal dorsal columns from clinical data. IEEE Trans Biomed Eng, 1998, 45(11): 1355–62.CrossRefGoogle Scholar
  111. 111.
    Holsheimer, J. and G. Barolat, Spinal geometry and paresthesia coverage in spinal cord stimulation. Neuromodulation, 1998, 1(3): 129–36.CrossRefGoogle Scholar
  112. 112.
    North, R.B., et al., Spinal cord stimulation for axial low back pain: a prospective, controlled trial comparing dual with single percutaneous electrodes. Spine, 2005, 30(12): 1412–8.CrossRefGoogle Scholar
  113. 113.
    Holsheimer, J., Effectiveness of spinal cord stimulation in the management of chronic pain: analysis of technical drawbacks and solutions. Neurosurgery, 1997, 40(5): 990–6; discussions 996–9.CrossRefGoogle Scholar
  114. 114.
    Holsheimer, J., et al., Clinical evaluation of paresthesia steering with a new system for spinal cord stimulation. Neurosurgery, 1998, 42(3): 541–7; discussion 547–9.CrossRefGoogle Scholar
  115. 115.
    Struijk, J.J., et al., Theoretical performance and clinical evaluation of transverse tripolar spinal cord stimulation. IEEE Trans Rehabil Eng, 1998, 6(3): 277–85.CrossRefGoogle Scholar
  116. 116.
    Kameyama, T., Y. Hashizume, and G. Sobue, Morphologic features of the normal human cadaveric spinal cord. Spine, 1996, 21(11): 1285–90.CrossRefGoogle Scholar
  117. 117.
    McIntyre, C.C., A.G. Richardson, and W.M. Grill, Modeling the excitability of mammalian nerve fibers: influence of afterpotentials on the recovery cycle. J Neurophysiol, 2002, 87(2): 995–1006.Google Scholar
  118. 118.
    Yearwood, T., Dorsal Column Selectivity in Pulse Width (PW) Programming of Spinal Cord Stimulation (SCS): the “Sacral Shift”, in 11th North American Neuromodulation Society, 2007: Acapulco, Mexico.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Michael A. Moffitt
    • 1
  • Dongchul C. Lee
    • 1
  • Kerry Bradley
    • 1
  1. 1.Boston Scientific Neuromodulation CorporationValenciaUSA

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