A neuromonitoring framework supporting the intraoperative placement of an epidural spinal cord electrode array for functional restoration in people with paraplegia

Abstract

Targeted stimulation of dorsal nerve roots of the lumbosacral spinal cord (SC) represents a promising way to improve lower extremity functions for people with paraplegia due to SC injury. Stimulation pulses are selectively applied at different segments of the SC by means of an implanted electrode array. For an optimal clinical outcome, correct positioning of the array in rostrocaudal and mediolateral direction of the SC is essential. We developed a neuromonitoring framework to support the neurosurgeon during the implantation procedure by automated stimulation and real-time analysis of evoked muscular responses. For the implementation we developed and combined a new software with several hardware and software modules for intraoperative neuromonitoring. The new software coordinates different interfaces and components including a neurostimulator, a multiplexer module and a biosignal amplifier. In addition, a graphical user interface (GUI) was implemented, allowing control of the system and display of analyzed data. With the framework, stimulation sequences in respect to stimulation amplitudes and selection of contacts of the electrode array can be predefined and executed in an automated manner. Synchronously the evoked electromyographic responses of the target muscles can be recorded, analyzed and displayed together with the stimulation setup for visual evaluation. The framework serves as a fundamental basis for the integration of a clinical knowledge-based algorithm and the realization of a future neuromonitoring system for this purpose.

Keywords

• rehabilitation
• intraoperative neuromonitoring
• paraplegia
• targeted stimulation
• electromyography