Four-limb Neurostimulation with Neuroelectrodes Placed in the Lower Cervical Epidural Space

SPINAL cord stimulation (SCS) involves electrical stimulation of large afferents (A beta fibers) in the dorsal columns of the spinal cord by neuroelectrodes placed in the epidural space. Stimulation elicits tingling sensation (paresthesiae) in the corresponding dermatome and inhibits small-diameter nociceptive afferents (A delta and C fibers), which transmit painful sensations.(1) Stimulation for painful entities involving the upper limbs typically requires cervical placement of neuroelectrodes, whereas stimulation for lower extremity pain entails placing the leads in the low thoracic spine.(2) Paresthesiae induced by SCS are generally sought over the targeted painful areas, (3-6) though subthreshold stimulation (stimulation below the perception threshold, not felt by the patient as paresthesiae) has recently been reported as effective. Clinical experience and a few case reports Suggest the possibility of obtaining stimulation in the lower extremity, in addition to upper extremity stimulation, with neuroelectrodes placed in the cervical epidural space.(9-11) Patients with pain in all four extremities that may be amenable to management with SCS may benefit from such intervention, provided that consistent and reproducible stimulation can be accomplished. The objective of this report is to determine whether it is feasible to consistently achieve stimulation coverage of all limbs with two percutaneous cervical leads placed in the epidural space of the lower cervical spine. In addition, short-term effectiveness of the modality was examined by functional outcomes in patients who proceeded to permanent implantation of cervical neuroelectrodes.