Spinal Cord Stimulator Electrode Targeting via Dermatome Mapping
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Solution Overview
Problem
Determining optimal stimulation parameters and locations in spinal cord stimulation therapy to effectively treat chronic pain remains a significant challenge.
Innovation Solution
An external system is used to receive pain inputs, provide test stimulations at different locations, and automatically determine an optimal location in the electrode array based on patient feedback, utilizing rostro-caudal and medio-lateral positions and dermatome maps to deliver targeted spinal cord stimulation.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If manual trial stimulation and parameter adjustment is performed, then the system can identify effective stimulation parameters, but the process is time-consuming and requires multiple patient visits
Solution Approach 1:
The system performs preliminary mapping of the patient's pain areas and dermatomes before optimization, and uses pre-stored anatomical data to guide the optimization process. This preliminary preparation enables faster parameter optimization in subsequent sessions.
Solution Approach 2:
The system implements automated feedback loops where patient responses to test stimulations are immediately processed by the controller to adjust stimulation parameters. This real-time feedback mechanism accelerates the identification of optimal parameters without requiring multiple separate visits.
2Measurement precision
If comprehensive test stimulations are performed at multiple locations, then optimal stimulation parameters can be identified, but the programming process becomes complex and time-consuming
Solution Approach 1:
The system divides the spinal cord stimulation area into distinct dermatomal regions and tests stimulation parameters locally in each region. This segmented approach allows systematic identification of optimal locations without overwhelming complexity.
Solution Approach 2:
The system uses pre-stored anatomical maps and dermatome patterns as templates to guide test stimulation locations. These standardized patterns reduce programming complexity by providing a structured framework for comprehensive testing.
3Measurement precision
If multiple test stimulations are administered to map pain areas, then accurate pain localization is achieved, but patient discomfort and procedure duration increase
Solution Approach 1:
The system administers test stimulations at progressively increasing intensities, starting with sub-threshold levels and only applying higher intensities when necessary for accurate mapping. This minimizes patient discomfort while maintaining localization accuracy.
Solution Approach 2:
The system uses patient-provided pain area markings and dermatome assessments as preliminary data to guide test stimulation locations. This preliminary information reduces the number of test locations needed, thereby reducing patient discomfort.
Data Source
AI summary
Methods and systems for determining an optimal stimulation location in an electrode array of a spinal cord stimulator are disclosed. An external system such as a clinician programmer includes a targeting algorithm implemented as part of a graphical user interface. Targeting algorithm provides test stimulation at extreme (e.g., top and bottom) locations in the electrode array, and medio-laterally centered such that the patient feels the stimulation equally on the right and left. These extreme locations are recorded, as are locations (e.g., dermatomes) on the patient that are affected. Targeting algorithm also receives an input information indicative of the location(s) (dermatome(s)) of the patient's pain. A position algorithm within the targeting algorithm can use this information to interpolate an optimal location in the electrode array to apply stimulation to treat the patient's pain.