Is Spinal Cord Stimulation Safe? A Review of its Complications
Is Spinal Cord Stimulation Safe? A Review of its Complications
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DOI：
10.1016/j.wneu.2013.06.012
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发表时间：
2014-12-01
影响因子：
2
通讯作者：
Yampolsky, Claudio
中科院分区：
文献类型：
--
作者：
Bendersky, Damian;Yampolsky, Claudio
目的：评价脊髓刺激(SCS)的并发症。方法：本文对有关SCS安全性的文献进行非系统综述。结果：电极移位是SCS最常见的并发症，经皮电极移位较桨叶电极更为常见。铅迁移可以通过重新编程刺激器来解决，但如果它扇动，手术重新定位是强制性的。在正文中描述了几种锚定技术。感染是一种与外科手术相关的潜在可减少的并发症，报道的感染率与几种神经调节装置的感染率相当。文中列出了预防SCS设备感染的建议。其他并发症包括电极断裂、延长线或植入式脉冲发生器失效、脑脊液漏、刺激器疼痛、硬脊膜外血肿等。结论：尽管存在多种并发症，SCS仍是一种安全的治疗方法。此外，危及生命的并发症发生率很低。医生必须保持警觉，以便在随访过程中识别出它们。根据文献中发表的建议，通过实施适当和严格的无菌外科技术，以及在植入前进行准确的患者选择，可以避免或至少减少并发症。
OBJECTIVE: We aim to evaluate the complications of spinal cord stimulation (SCS).METHODS: This article is a nonsystematic review of literature about the safety of SCS. The complications of this technique are described, focusing the analysis in their prevention, diagnosis, and treatment.RESULTS: Electrode migration is the most common complication of SCS and it is more frequent with percutaneous electrodes than with paddle-type ones. Lead migration may be solved by reprogramming the stimulator, but if it fans, surgical repositioning is mandatory. Several anchoring techniques are described in the text. Infection is a potentially reducible complication associated with the surgical procedure and the reported infection rates are comparable with those of several neuromodulation devices. Recommendations for the prevention of SCS device infections are listed in the article. Other complications were reviewed such as electrode fracture, extension wire or implantable pulse generator failures, cerebrospinal fluid leakage, pain over the stimulator, and spinal epidural hematoma, among others.CONCLUSION: In spite of the existence of several complications, SCS may be seen as a safe technique. Furthermore, the incidence of life-threatening complications is low. The physician must be alert to recognize them during the follow-up. Complications may be avoided or at least diminished by performing a proper and strict aseptic surgical technique as well as carrying out an accurate patient selection before the implantation, according to the recommendations published in the literature.