Postsurgical Pathologies Associated with Intradural Electrical Stimulation in the Central Nervous System: Design Implications for a New Clinical Device

BioMed Research International, 2014 · DOI: http://dx.doi.org/10.1155/2014/989175 · Published: April 1, 2014

Simple Explanation

Spinal cord stimulation has been used for treating conditions like failed back surgery and phantom limb syndromes. The placement of electrodes has evolved from subdural to epidural to reduce complications. This paper reviews complications related to subdural stimulation to inform the design of a new, safer approach. The Human Spinal Cord Modulation System (HSCMS), or “I-Patch” device, is a subdural implant with electrodes placed directly on the spinal cord's surface. This configuration minimizes the shunting of electrical currents and allows for more selective activation of spinal cord fibers. The HSCMS offers advantages over existing devices, such as fixed electrode placement and deeper penetration of electrical stimulation fields. However, it requires a more complex neurosurgical procedure and a robust postimplant seal to prevent CSF leaks.

Study Duration

Not specified

Participants

Review Article

Evidence Level

Not specified

Key Findings

1
Early subdural spinal cord stimulation encountered difficulties such as spinal cord injury, vascular compromise, infection, CSF leakage, hematoma formation, and chronic fibrosis.
2
Pathological effects of electrical stimulation on CNS tissue include increased permeability of blood vessels, vascular congestion, neuronal process swelling, gliosis, and myelin degeneration.
3
The mere presence of electrodes can lead to meningeal thickening, while the extent of fibrosis is also affected by electrical stimulation, indicating that subdural electrical stimulation can specifically incite meningeal fibrosis.

Research Summary

This review examines the pathologies associated with subdural electrical stimulation to inform the design of a new spinal cord stimulator (HSCMS). It revisits the original clinical approach to spinal cord stimulation, identifying challenges and complications from past subdural implantations. The authors discuss key pathologic findings related to subdural stimulation, including CSF leakage, vascular disruption, spinal cord contusion, infection, hematoma formation, chronic fibrosis, and pathology induced by electrical stimulation. The development of the HSCMS aims to address the shortcomings of existing epidural approaches by incorporating modern materials and design concepts. The device is designed to minimize complications such as CSF leakage, spinal cord compression, and lead breakage.

Practical Implications

Improved Device Design

Understanding past complications allows for the development of safer and more effective spinal cord stimulation devices.

Optimized Surgical Techniques

Knowledge of potential pathologies can guide the refinement of surgical procedures for subdural implantation.

Enhanced Patient Safety

Addressing historical issues can reduce the risk of adverse events and improve patient outcomes with spinal cord stimulation.

Study Limitations

1
Limited descriptions of overall complication rates in early literature.
2
Difficulty in directly comparing subdural and epidural implantation pathologies due to differences in procedures and device technology.
3
The need for further assessment and statistical analysis of clinical findings to arrive at meaningful results.

Your Feedback

Was this summary helpful?

Back to Neurology