Spinal cord stimulation for failed back surgery syndrome
Spinal cord stimulation for failed back surgery syndrome
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DOI：
10.1046/j.1525-1403.2001.00001.x
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发表时间：
2001-01-01
期刊：
影响因子：
2.8
通讯作者：
Gorecki, JP
中科院分区：
文献类型：
--
作者：
Leveque, JC;Villavicencio, AT;Gorecki, JP
目的：评价现代脊髓刺激疗法(SCS)治疗背部手术失败综合征(FBSS)的疗效。自1992年12月至1998年1月，30例因多次背部手术失败后腰痛和神经根性疼痛而接受SCS治疗。如果试验刺激导致疼痛减少50%，则植入永久性系统。中位长期随访期为34个月(6-66个月)。术后疼痛的严重程度由无私的第三方确定。结果，总体而言，接受永久植入物的16名患者中有12名(75%)在随访时继续报告至少50%的疼痛缓解。所有6名接受了胸段SCS椎板切除式电极置入的患者在长期随访中疼痛减轻了50%。视觉模拟评分平均下降3.2分(由术前8.6分降至术后5.4分)。经胸椎板切除置入SCS的患者VAS平均下降4.9，而经皮置入胸导联的患者VAS平均下降2.5。SCS是一种治疗慢性下腰腿痛的有效方法，保守治疗难以奏效，也无法进行矫正的解剖手术。虽然我们的患者人数很少，但我们的结果表明，胸段椎板切除式电极比经皮导联取得了更好的长期疗效。
Objective, The purpose of this study is to evaluate the effectiveness of modern spinal cord stimulation (SCS) for the treatment of failed back surgery syndrome (FBSS),Materials and Methods. Thirty patients were treated with SCS between December 1992 and January 1998 for low back and radicular pain after multiple failed back surgeries. Permanent systems were implanted if trial stimulation led to >50% pain reduction. Median long-term follow-up was 34 months (range, 6-66 months). Severity of pain was determined postoperatively by a disinterested third party.Results, Overall, 12 of the 16 patients (75%) who received permanent implants continued to report at least 50% relief of pain at follow-up. All six patients who underwent placement of laminectomy-styled electrode for SCS in the thoracic region had >50% pain relief at long-term follow-up. Visual analog scores decreased an average of 3.2 (from 8.6 preoperatively to 5.4 postoperatively). Patients undergoing SCS placement via laminectomy in the thoracic region experienced an average decrease of 4.9 in VAS, whereas those who underwent percutaneous placement of thoracic leads had an average decrease of 2.5.Conclusions. SCS is an effective treatment for chronic low back and lower extremity pain which is refractory to conservative therapy and which is not amenable to corrective anatomic surgery. Though our patient population is small, our results imply that the laminectomy-style electrodes in the thoracic region achieve better long-term effectiveness than percutaneous leads.