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(37) Modifying the Spinal Cord Stimulator Implant Procedure to Target the Ventro-lateral Spinal Cord

Friday, June 13, 2025
5:10 PM - 5:50 PM ET
Location: Sky View
Introduction: Spinal cord stimulation (SCS) is a chronic pain treatment, but is increasingly used in clinical trials for motor rehabilitation in conditions such as spinal cord injury, stroke, and Parkinson’s disease [1,2]. Typically, SCS involves placing leads epidurally on the dorsal side of the spinal cord (SCSD; Fig. 1), where the stimulation of large diameter afferent fibers in the dorsal roots indirectly activates motoneurons via reflex pathways [3]. Although SCSD can enhance motor rehabilitation, its efficacy has been limited by its lack of muscle-specific activation [3]. To address this limitation, we propose targeting the ventral spinal cord (SCSV; Fig. 1), closer to the motoneurons in the ventral horn. Here, we aim to refine the SCS electrode implant procedure to target the ventro-lateral aspect of the lumbosacral spinal cord in humans to target unilateral ventral roots and the ventral horn.

Methods: Six SCS leads were implanted in two cadaver specimens. Three leads were placed in a 22-year-old female cadaver, and the remaining three in a 68-year-old male cadaver. Experienced physiatrists and a neurosurgeon performed the lead insertion using an epidural Tuohy needle to access the dorsal epidural space under live fluoroscopic guidance. Leads 1-5 were implanted epidurally and steered laterally and around the spinal cord into the ventral epidural space, then guided rostrally to the target spinal level. Lead 6 was inserted transforaminally, anterior to the roots and guided rostrally within the ventral epidural space. The lead insertion and final placement levels are described in Table 1. Following each implant, the needle was removed, and computed tomography (CT) and dissection were performed to verify lead placement.

Results: CT and dissection revealed that, in the first cadaver, Leads 1 and 2 were positioned more laterally than intended, while Lead 3 was successfully placed ventro-laterally. In the second cadaver, all leads were successfully positioned ventro-laterally (Fig. 2). However, while inserting Lead 5 the dura mater was punctured and the lead travelled sub-durally.

Conclusion: The successful ventro-lateral placement of Leads 3, 4, and 6 supports the feasibility of this implant approach. The dural puncture is a known but rare occurrence with the SCS implant procedure and is more preventable in live tissue with cerebrospinal fluid inducing distention of the dura. The implant procedure will be further optimized in an additional cadaver. Successful ventro-lateral placement of SCS leads holds promise for more precise activation of lower-limb muscles, enhancing rehabilitation outcomes and quality of life for patients with movement disorders.