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本次文献选自Sheldon B , Staudt M D , Williams L , et al. Spinal cord stimulation programming: a crash course[J]. Neurosurgical Review, 2020:1-12.
Pulse width
Pulse width determines how focused or broad stimulation will be felt, and is therefore responsible for aiming the pain-relieving stimulation at the proper target. Increasing the pulse width widens the electric field, resulting in greater neuronal recruitment and potentially wider areas of anatomical coverage, although this must be balanced against off-target stimulation such as unwanted dorsal root activation. In some patients, this has been reported to cause a “caudal shift,” which is the recruitment of more caudal dermatomes, thus providing greater paresthesia coverage in tonic stimulation. Subparesthesia programming of pulse width requires similar consideration as for amplitude; this parameter is often not adjusted outside of a predetermined range, and gradual increases should be performed to identify potentially unpleasant stimulation.
脉宽
脉宽决定了感觉到的刺激是集中还是广泛，因此负责将缓解疼痛的刺激瞄准适当的目标。增加脉宽会使电场变宽，从而导致更多的神经元激活和潜在的更广泛的解剖覆盖区域，尽管必须与脱靶刺激（例如激活多余的背根）进行平衡。在某些患者中，据报道这会引起“末梢迁移”，即激活更多的末梢皮节，从而在常规刺激中提供更大的感觉异常覆盖。脉宽的亚感觉异常程控的注意事项与振幅类似。该参数通常不会在预定范围之外进行调整，应逐步增加以识别潜在的不愉快刺激。
This parameter directly correlates with amplitude, and the resultant “charge per pulse” determines the threshold for neuronal activation and action potential propagation. It is defined as the amount of time an electrical signal is delivering power to the system, measured in microseconds (μs). During initial programming for tonic stimulation, pulse width is typically set between 200 and 500 μs, and modern programming allows pulse widths up to 1000 μs. The stimulation field can be widened or narrowed by adjusting the pulse width, thereby changing the anatomical regions where stimulation is perceived. For example, a patient receiving SCS for lower limb and foot pain may report that the initial stimulation programming at a pulse width of 300 μs offers relief for their leg, but that it does not extend to their foot. Increasing pulse width beyond 300 μs may change the area of stimulation towards the foot, as would an increase in amplitude. However, this increased coverage must be balanced against potential side effects such as off-target stimulation or unpleasant paresthesias. The lead should also be checked to confirm that it is in the T7-10 position; the location of the active contacts in this region may differ for each individual patient.
该参数与振幅直接相关，他们组合成的“每脉冲电荷”决定了神经元激活和动作电位传播的阈值。它定义为电信号向系统供电的时间量，以微秒（μs）为单位。常规刺激初始程控期间，脉宽通常设置为200-500μs，新的程控程序允许脉宽达1000μs。通过调节脉宽，可以使刺激场变宽或变窄，从而改变感知刺激的解剖区域。例如，对于接受SCS的下肢和足部疼痛的患者来说，以300μs的脉宽进行的初始刺激程序可缓解他们的腿部疼痛，但不会扩展到其脚部。脉宽增加超过300μs可能会将刺激区域移至足部，就如振幅增加一般。但是，这种增加的覆盖范围必须与潜在的副作用（如脱靶刺激或不适感）相平衡。电极应确认其处于T7-10位置；对不同患者而言，工作触点在该区域中的位置可能会有所不同。
When pulse width is increased, the current penetration is increased and more motor units within the targeted nerve will exceed threshold and fire action potentials, leading to motor nerve stimulation. Thus, lower pulse widths have fewer side effects. Wider pulse widths allow for greater recruitment. In contrast, narrower pulse widths are preferred in dorsal root or dorsal root ganglion stimulation, and often when first programming cervical leads as well, in order to decrease the likelihood of motor unit recruitment.
当脉宽增加时，电流渗透会增加，目标神经内的更多运动单元将超过阈值并产生动作电位，从而导致运动神经受到刺激。因此，较低的脉宽具有较少的副作用。较宽的脉宽导致更多的神经元激活。相反，在背根或背根神经节刺激中，以及通常在第一次程控颈椎电极时，通常优选使用较窄的脉宽，以减少运动单元激活的可能性。
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