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

Veronika E Binder,Zoltán Száva,Ursula S Hofstoetter,Anna Rienmüller,Simon M Danner,Matthias J Krenn,Karen Minassian

doi:10.3390/jcm10235543

Abstract

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.

Highlights

Licensee MDPI, Basel, Switzerland.Transcutaneous lumbar spinal cord stimulation was designed to activate large-diameter posterior root afferent fibers through the use of skin-surface stimulation electrodes placed over the spine at the thoracolumbar junction, overlying the lumbosacral spinal cord, and indifferent electrodes over the anterior lower trunk [1]
posterior root-muscle (PRM) reflexes could be elicited in neutral and extended spine alignment conditions, flexed reflexes could be elicited in neutral and extended spine alignment conditions, flexed spine spine alignment resulted in a strong reduction of the response amplitudes and inacalignment resulted in a strong reduction of the response amplitudes and inactivation tivation of motor fibers
Transcutaneous spinal cord stimulation for neurophysiological studies as well as neuromodulative applications relies on the activation of sensory afferent fibers

Summary

Introduction

Transcutaneous lumbar spinal cord stimulation was designed to activate large-diameter posterior root afferent fibers through the use of skin-surface stimulation electrodes placed over the spine at the thoracolumbar junction, overlying the lumbosacral spinal cord, and indifferent electrodes over the anterior lower trunk [1]. To reliably apply transcutaneous lumbar spinal cord stimulation, posterior root afferent fibers must be activated selectively and consistently. Under certain conditions, anterior roots containing the axons of the spinal motoneurons can be (co-)activated [15,16] In neurophysiological studies, this (co-)activation would evoke direct M wave-like responses [1,2] that bypass the spinal sensorimotor circuits; in neuromodulation approaches, continuous contractions of the respectively innervated muscles would be generated, impeding the intended effects. We have previously shown that selective posterior root recruitment can be achieved when stimulation is applied in supine or normal upright standing positions [1,3,6,10,19], but when applied in the prone position, the thresholds of anterior root motor fibers relative to those of the posterior roots are decreased [19]

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Discussion

Conclusion