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Prospective Analysis Utilizing Intraoperative Neuromonitoring for the Evaluation of Inter-Burst Frequencies

Authors Falowski SM, Benison A

Received 3 January 2021

Accepted for publication 6 February 2021

Published 11 March 2021 Volume 2021:14 Pages 703—710

DOI https://doi.org/10.2147/JPR.S298797

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Dawood Sayed


Steven M Falowski, Alexander Benison

Neurosurgical Associates of Lancaster, Lancaster, PA, USA

Correspondence: Steven M Falowski
Director Functional Neurosurgery, Neurosurgical Associates of Lancaster, 160 N Pointe Blvd Suite 200, Lancaster, PA, 17601 Tel +44-358-0800
Email [email protected]

Background: Intraoperative neuromonitoring (IONM) for spinal cord stimulation (SCS) uses electromyography (EMG) responses to determine myotomal coverage as a marker for dermatomal coverage.
Objective: These responses can be utilized to evaluate the effects of stimulation platforms on the nervous system.
Methods: Eight patients were tested at inter-burst frequencies of 10 Hz, 20 Hz, 30 Hz, and 40 Hz using DeRidder Burst stimulation to determine the amplitude of onset of post-synaptic signal generation. Three patients had additional data recording amplitude of onset of tonic stimulation prior to and post DeRidder Burst stimulation at each inter-burst frequency. This represented post-synaptic excitability.
Results: In all patients, the DeRidder Burst waveform generated EMG responses under all inter-burst frequencies including temporal summation, deeper fiber recruitment, and compounded action potentials. There was a non-significant decrease of 7.6– 7.8% in amplitudes to generate response under 40 Hz, compared to the other frequencies. However, there was a 73.1% reduction in energy requirements at 10 Hz. The enhanced post-synaptic excitability effect was demonstrated at all frequencies.
Conclusion: DeRidder Burst has similar effects of temporal summation, deeper fiber recruitment, and compounded action potentials under IONM at 40 Hz, 30 Hz, 20 Hz, and 10 Hz. In addition, the hyperexcitability phenomenon was also observed regardless of the frequency. This demonstrates that postsynaptic responses captured via IONM may be a sensitive biomarker to SCS mechanism of action. In addition, lower inter-burst frequencies may have a similar clinical effect on pain relief thus reducing power consumption even further than current dosing paradigms.

Keywords: electromyogram, EMG, SCS, somatosensory evoked potentials, spinal cord stimulation, SSEPS, Burst, DeRidder Burst

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