Effects of cervical spinal cord stimulation on cerebral blood flow in the rat

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Object. Spinal cord stimulation (SCS) is frequently used for the treatment of chronic pain. Although the mechanisms by which SCS alleviates pain are unclear, they are believed to involve changes within the dorsal horn of the spinal cord. Spinal cord stimulation has also been found to cause significant vasodilation in the peripheral vasculature. The mechanisms underlying this effect are thought to involve sympathetic blockade. A rostral vasodilatory effect has also been described, but changes in cerebral blood flow (CBF) have been poorly delineated. Using laser Doppler flowmetry (LDF), the authors examined the effects of cervical SCS on CBF in rats.

Methods. Cervical SCS was found to result in a significant increase in cortical LDF values (83 ± 11% [mean ± standard error of the mean]). The increase in cortical LDF values was not accompanied by a significant increase in systemic blood pressure. Stimulation of the upper cervical spinal cord was more effective in inducing LDF changes than was that of the lower cervical cord. Changes in SDS-induced LDF values were significantly attenuated after spinal cord transection at the cervicomedullary junction and by the administration of the sympathetic blocker hexamethonium.

Conclusions. These results indicate that cervical SCS may induce cerebral vasodilation and that this effect may involve indirect effects on vasomotor centers in the brainstem as well as an alteration in sympathetic tone.

Article Information

Address reprint requests to: Oren Sagher, M.D., Section of Neurosurgery, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109. email: osagher@umich.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Graph showing the effect of cervical SCS on cerebral LDF values. Approximately 15 seconds after initiation of stimulation, LDF values increased significantly over baseline measurements. This increase in LDF values was unaccompanied by a significant change in systemic blood pressure (BP). Values are expressed as mean ± SEM.

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    Graph showing the effects of SCS at several cervical levels on cerebral LDF values. High cervical (C-1 or C-3) stimulation resulted in significant increases in LDF values, whereas low cervical (C-6) stimulation did not. Values are expressed as mean ± SEM.

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    Graph illustrating the effects of cervicomedullary transection on SCS-induced LDF changes. Following transection, the effect of cervical SCS on cerebral LDF was attenuated. Values are expressed as mean ± SEM.

  • View in gallery

    Graph showing the effect of sympathetic blockade on SCS-induced LDF changes. Following the administration of hexamethonium, the LDF changes seen with cervical SCS were abolished. Values are expressed as mean ± SEM.

References

1.

Broseta JGarcía-March GSánchez-Ledesma MJet al: High-cervical spinal cord electrical stimulation in brain low perfusion syndromes: experimental basis and preliminary clinical report. Stereotact Funct Neurosurg 62:1711781994Broseta J García-March G Sánchez-Ledesma MJ et al: High-cervical spinal cord electrical stimulation in brain low perfusion syndromes: experimental basis and preliminary clinical report. Stereotact Funct Neurosurg 62:171–178 1994

2.

Cook AWOygar ABaggenstos Pet al: Vascular disease of extremities. Electric stimulation of spinal cord and posterior roots. N Y State J Med 76:3663681976Cook AW Oygar A Baggenstos P et al: Vascular disease of extremities. Electric stimulation of spinal cord and posterior roots. N Y State J Med 76:366–368 1976

3.

Croom JEForeman RDChandler MJet al: Role of nitric oxide in cutaneous blood flow increases in the rat hindpaw during dorsal column stimulation. Neurosurgery 40:5655711997Croom JE Foreman RD Chandler MJ et al: Role of nitric oxide in cutaneous blood flow increases in the rat hindpaw during dorsal column stimulation. Neurosurgery 40:565–571 1997

4.

de Jongste MJHautvast RWHillege HLet al: Efficacy of spinal cord stimulation as adjuvant therapy for intractable angina pectoris: a prospective, randomized clinical study. Working Group on Neurocardiology. J Am Coll Cardiol 23:159215971994de Jongste MJ Hautvast RW Hillege HL et al: Efficacy of spinal cord stimulation as adjuvant therapy for intractable angina pectoris: a prospective randomized clinical study. Working Group on Neurocardiology. J Am Coll Cardiol 23:1592–1597 1994

5.

Doba NReis DJ: Changes in regional blood flow and cardiodynamics evoked by electrical stimulation of the fastigial nucleus in the cat and their similarity to orthostatic reflexes. J Physiol 227:7297471972Doba N Reis DJ: Changes in regional blood flow and cardiodynamics evoked by electrical stimulation of the fastigial nucleus in the cat and their similarity to orthostatic reflexes. J Physiol 227:729–747 1972

6.

García-March GSánchez-Ledesma MJAnaya Jet al: [Cerebral and carotid haemodynamic changes following cervical spinal cord stimulation. An experimental study.] Acta Neurochir Suppl 46:1021041989 (Ger)García-March G Sánchez-Ledesma MJ Anaya J et al: [Cerebral and carotid haemodynamic changes following cervical spinal cord stimulation. An experimental study.] Acta Neurochir Suppl 46:102–104 1989 (Ger)

7.

Golanov EVReis DJ: Nitric oxide and prostanoids participate in cerebral vasodilation elicited by electrical stimulation of the rostral ventrolateral medulla. J Cereb Blood Flow Metab 14:4925021994Golanov EV Reis DJ: Nitric oxide and prostanoids participate in cerebral vasodilation elicited by electrical stimulation of the rostral ventrolateral medulla. J Cereb Blood Flow Metab 14:492–502 1994

8.

Hautvast RWTer Horst GJDeJong BMet al: Relative changes in regional cerebral blood flow during spinal cord stimulation in patients with refractory angina pectoris. Eur J Neurosci 9:117811831997Hautvast RW Ter Horst GJ DeJong BM et al: Relative changes in regional cerebral blood flow during spinal cord stimulation in patients with refractory angina pectoris. Eur J Neurosci 9:1178–1183 1997

9.

Horsch SClaeys L: Epidural spinal cord stimulation in the treatment of severe peripheral arterial occlusive disease. Ann Vasc Surg 8:4684741994Horsch S Claeys L: Epidural spinal cord stimulation in the treatment of severe peripheral arterial occlusive disease. Ann Vasc Surg 8:468–474 1994

10.

Hosobuchi Y: Electrical stimulation of the cervical spinal cord increases cerebral blood flow in humans. Appl Neurophysiol 48:3723761985Hosobuchi Y: Electrical stimulation of the cervical spinal cord increases cerebral blood flow in humans. Appl Neurophysiol 48:372–376 1985

11.

Hosobuchi Y: Treatment of cerebral ischemia with electrical stimulation of the cervical spinal cord. Pacing Clin Electrophysiol 14:1221261991Hosobuchi Y: Treatment of cerebral ischemia with electrical stimulation of the cervical spinal cord. Pacing Clin Electrophysiol 14:122–126 1991

12.

Huber SJVaglienti RMMidcap ME: Enhanced limb salvage for peripheral vascular disease with the use of spinal cord stimulation. W V Med J 92:89911996Huber SJ Vaglienti RM Midcap ME: Enhanced limb salvage for peripheral vascular disease with the use of spinal cord stimulation. W V Med J 92:89–91 1996

13.

Iadecola CNakai MMraovitch Set al: Global increase in cerebral metabolism and blood flow produced by focal electrical stimulation of dorsal medullary reticular formation in rat. Brain Res 272:1011141983Iadecola C Nakai M Mraovitch S et al: Global increase in cerebral metabolism and blood flow produced by focal electrical stimulation of dorsal medullary reticular formation in rat. Brain Res 272:101–114 1983

14.

Isono MKaga AFujiki Met al: Effect of spinal cord stimulation on cerebral blood flow in cats. Stereotact Funct Neurosurg 64:40461995Isono M Kaga A Fujiki M et al: Effect of spinal cord stimulation on cerebral blood flow in cats. Stereotact Funct Neurosurg 64:40–46 1995

15.

Jacobs MJJorning PJBeckers RCet al: Foot salvage and improvement of microvascular blood flow as a result of epidural spinal cord electrical stimulation. J Vasc Surg 12:3543601990Jacobs MJ Jorning PJ Beckers RC et al: Foot salvage and improvement of microvascular blood flow as a result of epidural spinal cord electrical stimulation. J Vasc Surg 12:354–360 1990

16.

Jivegard LEAugustinsson LEHolm Jet al: Effects of spinal cord stimulation (SCS) in patients with inoperable severe lower limb ischaemia: a prospective randomised controlled study. Eur J Vasc Endovasc Surg 9:4214251995Jivegard LE Augustinsson LE Holm J et al: Effects of spinal cord stimulation (SCS) in patients with inoperable severe lower limb ischaemia: a prospective randomised controlled study. Eur J Vasc Endovasc Surg 9:421–425 1995

17.

Linderoth BFedorcsak IMeyerson BA: Peripheral vasodilatation after spinal cord stimulation: animal studies of putative effector mechanisms. Neurosurgery 28:1871951991Linderoth B Fedorcsak I Meyerson BA: Peripheral vasodilatation after spinal cord stimulation: animal studies of putative effector mechanisms. Neurosurgery 28:187–195 1991

18.

Linderoth BGunasekera LMeyerson BA: Effects of sympathectomy on skin and muscle microcirculation during dorsal column stimulation: animal studies. Neurosurgery 29:8748791991Linderoth B Gunasekera L Meyerson BA: Effects of sympathectomy on skin and muscle microcirculation during dorsal column stimulation: animal studies. Neurosurgery 29:874–879 1991

19.

Linderoth BHerregodts PMeyerson BA: Sympathetic mediation of peripheral vasodilation induced by spinal cord stimulation: animal studies of the role of cholinergic and adrenergic receptor subtypes. Neurosurgery 35:7117191994Linderoth B Herregodts P Meyerson BA: Sympathetic mediation of peripheral vasodilation induced by spinal cord stimulation: animal studies of the role of cholinergic and adrenergic receptor subtypes. Neurosurgery 35:711–719 1994

20.

Long DMErickson DCampbell Jet al: Electrical stimulation of the spinal cord and peripheral nerves for pain control. A 10-year experience. Appl Neurophysiol 44:2072171981Long DM Erickson D Campbell J et al: Electrical stimulation of the spinal cord and peripheral nerves for pain control. A 10-year experience. Appl Neurophysiol 44:207–217 1981

21.

Mannheimer CEliasson TAugustinsson LEet al: Electrical stimulation versus coronary artery bypass surgery in severe angina pectoris: the ESBY study. Circulation 97:115711631998Mannheimer C Eliasson T Augustinsson LE et al: Electrical stimulation versus coronary artery bypass surgery in severe angina pectoris: the ESBY study. Circulation 97:1157–1163 1998

22.

Matsui THosobuchi Y: The effects of cervical spinal cord stimulation (cSCS) on experimental stroke. Pacing Clin Electrophysiol 12:7267321989Matsui T Hosobuchi Y: The effects of cervical spinal cord stimulation (cSCS) on experimental stroke. Pacing Clin Electrophysiol 12:726–732 1989

23.

Mazzone PPisani RPizio Net al: Cerebral blood flow and somatosensory evoked response changes induced by spinal cord stimulation: preliminary follow-up observations. Stereotact Funct Neurosurg 62:1791851994Mazzone P Pisani R Pizio N et al: Cerebral blood flow and somatosensory evoked response changes induced by spinal cord stimulation: preliminary follow-up observations. Stereotact Funct Neurosurg 62:179–185 1994

24.

Meglio MCioni BRossi GF: Spinal cord stimulation in management of chronic pain. A 9-year experience. J Neurosurg 70:5195241989Meglio M Cioni B Rossi GF: Spinal cord stimulation in management of chronic pain. A 9-year experience. J Neurosurg 70:519–524 1989

25.

Mingoli ASciacca VTamorri Met al: Clinical results of epidural spinal cord electrical stimulation in patients affected with limb-threatening chronic arterial obstructive disease. Angiology 44:21251993Mingoli A Sciacca V Tamorri M et al: Clinical results of epidural spinal cord electrical stimulation in patients affected with limb-threatening chronic arterial obstructive disease. Angiology 44:21–25 1993

26.

Modesti LMWaszak M: Firing pattern of cells in human thalamus during dorsal column stimulation. Appl Neurophysiol 38:2512581975Modesti LM Waszak M: Firing pattern of cells in human thalamus during dorsal column stimulation. Appl Neurophysiol 38:251–258 1975

27.

Momose TMatsui TKosaka Net al: Effect of cervical spinal cord stimulation (cSCS) on cerebral glucose metabolism and blood flow in a vegetative patient assessed by positron emission tomography (PET) and single photon emission computed tomography (SPECT). Radiat Med 7:2432461989Momose T Matsui T Kosaka N et al: Effect of cervical spinal cord stimulation (cSCS) on cerebral glucose metabolism and blood flow in a vegetative patient assessed by positron emission tomography (PET) and single photon emission computed tomography (SPECT). Radiat Med 7:243–246 1989

28.

Myklebust JBCusick JFBoerboom LEet al: Vascular effects of spinal cord stimulation in the monkey. Stereotact Funct Neurosurg 64:32391995Myklebust JB Cusick JF Boerboom LE et al: Vascular effects of spinal cord stimulation in the monkey. Stereotact Funct Neurosurg 64:32–39 1995

29.

Nakai MIadecola CReis DJ: Global cerebral vasodilation by stimulation of rat fastigial cerebellar nucleus. Am J Physiol 243:H2262351982Nakai M Iadecola C Reis DJ: Global cerebral vasodilation by stimulation of rat fastigial cerebellar nucleus. Am J Physiol 243:H226–235 1982

30.

Nakai MIadecola CRuggiero DAet al: Electrical stimulation of cerebellar fastigial nucleus increases cerebral cortical blood flow without change in local metabolism: evidence for an intrinsic system in brain for primary vasodilation. Brain Res 260:35491983Nakai M Iadecola C Ruggiero DA et al: Electrical stimulation of cerebellar fastigial nucleus increases cerebral cortical blood flow without change in local metabolism: evidence for an intrinsic system in brain for primary vasodilation. Brain Res 260:35–49 1983

31.

North RBEwend MGLawton MTet al: Failed back surgery syndrome: 5-year follow-up after spinal cord stimulator implantation. Neurosurgery 28:6926991991North RB Ewend MG Lawton MT et al: Failed back surgery syndrome: 5-year follow-up after spinal cord stimulator implantation. Neurosurgery 28:692–699 1991

32.

North RBKidd DHZahurak Met al: Spinal cord stimulation for chronic, intractable pain: experience over two decades. Neurosurgery 32:3843951993North RB Kidd DH Zahurak M et al: Spinal cord stimulation for chronic intractable pain: experience over two decades. Neurosurgery 32:384–395 1993

33.

Stanton-Hicks MSalamon J: Stimulation of the central and peripheral nervous system for the control of pain. J Clin Neurophysiol 14:46621997Stanton-Hicks M Salamon J: Stimulation of the central and peripheral nervous system for the control of pain. J Clin Neurophysiol 14:46–62 1997

34.

Underwood MDIadecola CSved Aet al: Stimulation of C-1 area neurons globally increases regional cerebral blood flow but not metabolism. J Cereb Blood Flow Metab 12:8448551992Underwood MD Iadecola C Sved A et al: Stimulation of C-1 area neurons globally increases regional cerebral blood flow but not metabolism. J Cereb Blood Flow Metab 12:844–855 1992

35.

Visocchi MCioni BPentimalli Let al: Increase of cerebral blood flow and improvement of brain motor control following spinal cord stimulation in ischemic spastic hemiparesis. Stereotact Funct Neurosurg 62:1031071994Visocchi M Cioni B Pentimalli L et al: Increase of cerebral blood flow and improvement of brain motor control following spinal cord stimulation in ischemic spastic hemiparesis. Stereotact Funct Neurosurg 62:103–107 1994

36.

Visocchi MCioni BVergari Set al: Spinal cord stimulation and cerebral blood flow: an experimental study. Stereotact Funct Neurosurg 62:1861901994Visocchi M Cioni B Vergari S et al: Spinal cord stimulation and cerebral blood flow: an experimental study. Stereotact Funct Neurosurg 62:186–190 1994

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