Neurophysiological Evidence of Antidromic Activation of Large Myelinated Fibres in Lower Limbs During Spinal Cord Stimulation

A 46-year-old female patient experienced severe pain in both lower limbs following a traffic accident in 2008. The pain mainly presented in her feet; she also experienced sensory impairment, convulsions, and exercise function disorders. She was diagnosed with neuropathic pain, and no medicine had any remarkable effect. Therefore, spinal cord stimulation (SCS) was performed in October 2019. Her pain did not reduce after the initial adoption of conventional SCS until the application of high frequency SCS (HF-SCS). At the 6-month follow-up, the pain in her lower limbs was considerably reduced, lower limb motor function was slightly improved, and muscle twitching in both feet disappeared.

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Spinal Cord Stimulation as a Treatment Option for Refractory Chemotherapy-Induced Peripheral Neuropathy: Case Report

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0040-1709985 ◽

2020 ◽

Vol 39 (03) ◽

pp. 228-231 ◽

Cited By ~ 1

Author(s):

Arthur Lopes ◽

Kleber Duarte ◽

Catarina Lins ◽

Gabriel Kubota ◽

Valquíria Silva ◽

...

Keyword(s):

Colorectal Cancer ◽

Spinal Cord ◽

Neuropathic Pain ◽

Case Report ◽

Peripheral Neuropathy ◽

Treatment Option ◽

Spinal Cord Stimulation ◽

Lower Limbs ◽

Oncological Diseases ◽

Good Treatment Option

AbstractColorectal cancer is one of the most common oncological diseases. Chemotherapy is usually recommended as an adjuvant treatment for stage-II, -III, and -IV tumors. Approximately 10% of the patients develop neuropathic pain after chemotherapy, and they may remain refractory despite the administration of drugs that are commonly used to treat neuropathic pain. Spinal cord stimulation is a good treatment option for neuropathic pain of the lower limbs, and it should be trialed in patients with chemotherapy-induced peripheral neuropathy. We report the case of a patient with oxaliplatin-induced neuropathy and neuropathic pain refractory to oral medication who was successfully treated by spinal cord stimulation.

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The differential effect of the level of spinal cord stimulation on patients with advanced peripheral vascular disease in the lower limbs

British Journal of Neurosurgery ◽

10.1080/02688699844583 ◽

1998 ◽

Vol 12 (5) ◽

pp. 402-408 ◽

Cited By ~ 26

Author(s):

A. W. Ghajar, ◽

J. B. Miles

Keyword(s):

Spinal Cord ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Spinal Cord Stimulation ◽

Differential Effect ◽

Lower Limbs ◽

Peripheral Vascular

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The Usefulness of Spinal Cord Stimulation for Chronic Pain Due to Combined Vasospastic Prinzmetal Angina and Diabetic Neuropathic Pain of the Lower Limbs

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0034-1543960 ◽

2015 ◽

Vol 77 (02) ◽

pp. 176-178

Author(s):

Bogdan Pintea ◽

Thomas Kinfe

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Neuropathic Pain ◽

Spinal Cord Stimulation ◽

Lower Limbs ◽

Diabetic Neuropathic Pain

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Respiratory resetting induced by spinal cord stimulation in the cat

Journal of Applied Physiology ◽

10.1152/jappl.1988.65.4.1572 ◽

1988 ◽

Vol 65 (4) ◽

pp. 1572-1578 ◽

Cited By ~ 4

Author(s):

D. F. Speck

Keyword(s):

Spinal Cord ◽

Phrenic Nerve ◽

Spinal Cord Stimulation ◽

Cervical Spinal Cord ◽

Respiratory Rhythm ◽

Early Response ◽

Lumbar Spinal Cord ◽

Antidromic Activation ◽

Lateral Region ◽

Stimulation Of

Electrical stimulation (50-150 microA, 0.5-ms duration, 3-300 Hz) was performed within three different regions (lateral, ventrolateral, and ventral) of the C2-C3 spinal cord of decerebrate, vagotomized, paralyzed, and artificially ventilated cats. Spinal cord stimulation sites were located by inserting monopolar or bipolar stimulating electrodes either at the dorsolateral sulcus or at least 1 mm medial or lateral to the sulcus. With stimulation at each site, alterations in respiratory rhythm, orthodromic phrenic nerve responses, and antidromic activation of medullary respiratory-modulated neurons were examined. Phrenic nerve responses to cervical spinal cord stimulation consisted of an early excitation (2-4 ms) and/or a late excitation (4-8 ms). Stimulation of the lateral region evoked the greatest amplitude early response and stimulation of the ventrolateral region produced the greatest late excitation. All three stimulus sites elicited antidromic activation of some respiratory-modulated neurons in the dorsal (DRG) and ventral respiratory groups (VRG). The lateral region was the least effective resetting site, and it had the highest incidence of antidromic activation of both DRG and VRG neurons. The ventrolateral region of the cervical spinal cord was the most effective resetting site, but it had the lowest incidence of antidromic activation of DRG respiratory-modulated neurons. In addition, resetting responses were observed with spinal cord stimulation at similar sites in the thoracic and lumbar spinal cord regions thought to be devoid of inspiratory bulbospinal axons.(ABSTRACT TRUNCATED AT 250 WORDS)

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25.9 Epidural spinal cord stimulation in patients with critical ischaemia of the lower limbs: the response of cervical and scalp-recorded short latency somatosensory evoked

Cardiovascular Surgery ◽

10.1016/s0967-2109(97)80100-7 ◽

1997 ◽

Vol 5 ◽

pp. 128

Author(s):

C SETACCI

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Short Latency ◽

Lower Limbs ◽

Epidural Spinal Cord Stimulation ◽

Critical Ischaemia

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Influence of Spine Curvature on the Efficacy of Transcutaneous Lumbar Spinal Cord Stimulation

Journal of Clinical Medicine ◽

10.3390/jcm10235543 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5543

Author(s):

Veronika E. Binder ◽

Ursula S. Hofstoetter ◽

Anna Rienmüller ◽

Zoltán Száva ◽

Matthias J. Krenn ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Thoracolumbar Spine ◽

Lower Limbs ◽

Lumbar Spinal Cord ◽

Specific Effects ◽

Afferent Fibers ◽

Lumbar Spinal ◽

Transcutaneous Spinal Cord Stimulation ◽

Spinal Flexion

Transcutaneous spinal cord stimulation is a non-invasive method for neuromodulation of sensorimotor function. Its main mechanism of action results from the activation of afferent fibers in the posterior roots—the same structures as targeted by epidural stimulation. Here, we investigated the influence of sagittal spine alignment on the capacity of the surface-electrode-based stimulation to activate these neural structures. We evaluated electromyographic responses evoked in the lower limbs of ten healthy individuals during extension, flexion, and neutral alignment of the thoracolumbar spine. To control for position-specific effects, stimulation in these spine alignment conditions was performed in four different body positions. In comparison to neutral and extended spine alignment, flexion of the spine resulted in a strong reduction of the response amplitudes. There was no such effect on tibial-nerve evoked H reflexes. Further, there was a reduction of post-activation depression of the responses to transcutaneous spinal cord stimulation evoked in spinal flexion. Thus, afferent fibers were reliably activated with neutral and extended spine alignment. Spinal flexion, however, reduced the capacity of the stimulation to activate afferent fibers and led to the co-activation of motor fibers in the anterior roots. This change of action was due to biophysical rather than neurophysiological influences. We recommend applying transcutaneous spinal cord stimulation in body positions that allow individuals to maintain a neutral or extended spine.

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Spinal cord stimulation in peripheral arterial disease

Journal of Neurosurgery ◽

10.3171/jns.1986.64.1.0071 ◽

1986 ◽

Vol 64 (1) ◽

pp. 71-80 ◽

Cited By ~ 166

Author(s):

Jaime Broseta ◽

José Barberá ◽

J. A. de Vera ◽

Juan Luis Barcia-Salorio ◽

Guillermo Garcia-March ◽

...

Keyword(s):

Spinal Cord ◽

Peripheral Arterial Disease ◽

Spinal Cord Stimulation ◽

Arterial Disease ◽

Lower Limbs ◽

Peripheral Blood Flow ◽

Thoracic Spinal Cord ◽

Arterial Blood ◽

Thoracic Spinal ◽

Peripheral Arterial

✓ Percutaneous epidural Stimulation of the low thoracic spinal cord was carried out in 41 patients with pain from peripheral arterial disease of the lower limbs. Results are reported relating to pain, claudication distance, peripheral blood flow, and trophic lesion changes. Following a trial period of stimulation, 37 patients had stimulators permanently implanted. After a mean poststimulation follow-up period of 25 months, substantial pain relief (75% to 100%) was obtained in 29 cases; claudication distance significantly increased in 15 cases; Doppler ultrasound recordings of lower-limb distal arteries showed a tendency toward normalization of pulse-wave morphology, with increase of amplitude in 12 of the 23 patients studied; a rise in skin temperature was also detected by thermography. Distal arterial blood pressure remained unchanged with stimulation. Ischemic cutaneous trophic lesions of less than 3 sq cm healed, but gangrenous conditions were not benefited. A placebo effect or the natural history of the disease can be excluded as the reason for these improvements. It is concluded that spinal cord stimulation is a valid alternative treatment for moderate peripheral arterial disorders when direct arterial surgery is not possible or has been unsuccessful.

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