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Papers of the Week

Papers: 29 Jul 2023 - 4 Aug 2023

2023 Aug 02

J Neural Eng


Evoked compound action potentials during spinal cord stimulation: effects of posture and pulse width on signal features and neural activation within the spinal cord.


Brucker-Hahn MK, Zander HJ, Will AJ, Vallabh JC, Wolff JS, Dinsmoor DA, Lempka SF


Evoked compound action potential (ECAP) recordings have emerged as a quantitative measure of the neural response during spinal cord stimulation (SCS) to treat pain. However, utilization of ECAP recordings to optimize stimulation efficacy requires an understanding of the factors influencing these recordings and their relationship to the underlying neural activation. Approach. We acquired a library of ECAP recordings from 56 patients over a wide assortment of postures and stimulation parameters, and then processed these signals to quantify several aspects of these recordings (e.g., ECAP threshold, amplitude, latency, growth rate). We compared our experimental findings against a computational model that examined the effect of variable distances between the spinal cord and the SCS electrodes. Main results. Postural shifts strongly influenced the experimental ECAP recordings, with a 65.7% lower ECAP threshold and 178.5% higher growth rate when supine versus seated. The computational model exhibited similar trends, with a 71.9% lower ECAP threshold and 231.5% higher growth rate for a 2.0-mm cerebrospinal fluid layer (representing a supine posture) versus a 4.4-mm cerebrospinal fluid layer (representing a prone posture). Furthermore, the computational model demonstrated that constant ECAP amplitudes may not equate to a constant degree of neural activation. Significance. These results demonstrate large variability across all ECAP metrics and the inability of a constant ECAP amplitude to provide constant neural activation. These results are critical to improve the delivery, efficacy, and robustness of clinical SCS technologies utilizing these ECAP recordings to provide closed-loop stimulation. .