Abstract
The issue of whether one electrode placed over the physiologic midline provides better stimulation than two parallel electrodes placed on both sides of midline is one with which I struggled with for many years. I was strongly convinced that to obtain bilateral symmetrical paresthesiae one single midline lead was superior to two parallel leads. After years of going back and forth between the two methods, I finally came to a conclusion: even though one single electrode placed perfectly in the physiologic midline does provide the best stimulation of the dorsal columns, it is not a practical way to implement spinal cord stimulation for ongoing pain control. It is like saying that winning the lottery is the best way to make money. It is true (and sure it is wonderful when that happens), but it is not something that anybody would realistically count on. Several factors come into play:
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