Katie Rousseau
Erich Richter, M.D.
LSU Health Sciences Center, New Orleans
Spinal Cord Stimulation
 Important treatment for chronic neuropathic back and
leg pain
 SCS has traditionally been more effective for the
treatment of leg pain than for low back pain1
Current techniques
 Clinical efficacy depends
on paresthesia coverage of
the painful area
 There are several
techniques for
implantation
 Awake placement
 General anesthesia with
fluroscopy
 General anesthesia with
EMG mapping
Objective
 If a patient has low back paresthesia with a specific set
of stimulation parameters when prone, how likely are
they to still have low back paresthesia with the same
stimulation parameters when they are sitting?
 Determine the predictive value of prone low back
paresthesia for sitting low back paresthesia
Methods
 Patients were examined at routine follow up after
implantation of permanent paddle lead
 A series of programming combinations was tested to
determine which combinations gave low back
paresthesia coverage while prone
 These combinations were then tested in the sitting
position to determine if they still gave low back
coverage
 8 males, 3 females, ages 44 to 81
Example 1: Prone
Example 1: Sitting
R lower back
R hip
R buttock
R upper thigh
R lower thigh
R knee
R upper leg
R lower leg
R foot
L lower back
L hip
L buttock
L upper thigh
L lower thigh
L knee
L upper leg
L lower leg
L foot
Example 1: Graph
Legend:
L: left
R: right
0: no paresthesia
1: paresthesia present
1
0
prone
sitting
Example 2: Graph
Legend:
L: left
R: right
0: no paresthesia
1: paresthesia present
1
Sitting
0
Prone
Prone
Sitting
Results
 Only 58.1% of the settings that generated paresthesia
in the low back in the prone position also generated
the same coverage while upright
 However, successful coverage could be reliably found
in all patients when using an electrode with coverage
redundancy
Conclusions
 Specific electrode combinations producing paresthesia
in the low back in the prone position are unreliable at
producing the same pattern when sitting
 This may have implications for intraoperative
physiologic mapping
 However, it appears possible to capture the low back
with moderate programming changes
Acknowledgements
 Funded by Alpha Omega Alpha’s Carolyn L. Kuckein
Student Research Fellowship
Questions?