Spinal cord stimulation paresthesia and activity of primary afferents: Case report

Richard B. North, Karen Streelman, Lance Rowland, Perry Foreman

Research output: Contribution to journalArticle

Abstract

A patient with failed back surgery syndrome reported paresthesia in his hands and arms during a spinal cord stimulation (SCS) screening trial with a low thoracic electrode. The patient's severe thoracic stenosis necessitated general anesthesia for simultaneous decompressive laminectomy and SCS implantation for chronic use. Use of general anesthesia gave the authors the opportunity to characterize the patient's unusual distribution of paresthesia. During SCS implantation, they recorded SCS-evoked antidromic potentials at physiologically relevant amplitudes in the legs to guide electrode placement and in the arms as controls. Stimulation of the dorsal columns at T-8 evoked potentials in the legs (common peroneal nerves) and at similar thresholds, consistent with the sensation of paresthesia in the arms, in the right ulnar nerve. The authors' electrophysiological observations support observations by neuroanatomical specialists that primary afferents can descend several (in this case, at least 8) vertebral segments in the spinal cord before synapsing or ascending. This report thus confirms a physiological basis for unusual paresthesia distribution associated with thoracic SCS.

Original languageEnglish (US)
Pages (from-to)363-366
Number of pages4
JournalJournal of Neurosurgery: Spine
Volume17
Issue number4
DOIs
StatePublished - Oct 2012

Fingerprint

Spinal Cord Stimulation
Paresthesia
Arm
Thorax
Evoked Potentials
General Anesthesia
Leg
Electrodes
Failed Back Surgery Syndrome
Peroneal Nerve
Ulnar Nerve
Laminectomy
Spinal Cord
Pathologic Constriction
Hand

Keywords

  • Case study
  • Evoked potential
  • Neuroanatomy
  • Side effect
  • Spinal cord stimulation
  • Stimulation paresthesia

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neurology

Cite this

Spinal cord stimulation paresthesia and activity of primary afferents : Case report. / North, Richard B.; Streelman, Karen; Rowland, Lance; Foreman, Perry.

In: Journal of Neurosurgery: Spine, Vol. 17, No. 4, 10.2012, p. 363-366.

Research output: Contribution to journalArticle

North, Richard B. ; Streelman, Karen ; Rowland, Lance ; Foreman, Perry. / Spinal cord stimulation paresthesia and activity of primary afferents : Case report. In: Journal of Neurosurgery: Spine. 2012 ; Vol. 17, No. 4. pp. 363-366.
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