Cervical and cervicomedullary spinal cord stimulation for chronic pain: Efficacy and outcomes
Cervical and cervicomedullary spinal cord stimulation for chronic pain: Efficacy and outcomes
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DOI：
10.1016/j.clineuro.2014.09.023
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发表时间：
2014-12-01
影响因子：
1.9
通讯作者：
Moossy, John J.
中科院分区：
文献类型：
--
作者：
Chivukula, Srinivas;Tempel, Zachary J.;Moossy, John J.
背景：脊髓刺激 (SCS) 在治疗涉及颈部皮区或颈髓交界处 (CMJ) 的慢性脊髓疼痛（涉及颈部皮区或面部疼痛的颈髓交界处 (CMJ)）方面的作用在很大程度上仍是未知的。目的：回顾由单一外科医生进行颈部和 CMJ SCS 的结果，特别强调并发症和疗效。方法：通过电话问卷调查确定所有接受主要作者进行颈部或 CMJ SCS 的患者并进行随访。所有确定的患者的患者人口统计、手术细节、结果和并发症均经过严格审查。结果：在 121 名至少接受过试验性 SCS 的患者中，100 名接受了永久性导线植入。颈椎 SCS 的适应症包括臂丛神经病变 (8)、复杂区域疼痛综合征 (33)、退行性椎间盘疾病 (4)、颈部手术失败综合征 (23)、慢性神经根病 (6) 和带状疱疹后神经痛 (PHN) (1)； CMJ SCS 的适应症包括三叉神经脱神经痛 (10)、三叉神经性疼痛 (4)、PHN (4) 和枕神经痛 (7)。四肢的疼痛缓解效果比轴向的疼痛缓解效果好，枕骨区域的疼痛缓解效果比头部或面部的疼痛缓解效果要差。平均随访 4.2 年，平均疼痛减轻 56.6%。在需要进行的 24 例翻修手术中，有 8 例是因为推测的导线移位或断裂。并发症包括 4 例脑脊液漏、5 例伤口感染以及 4 例持续麻木或疼痛。疼痛缓解平均持续 3.6 年。结论：颈椎和 CMJ SCS 安全有效，并且沿上肢的疼痛缓解效果优于轴向疼痛，头部的疼痛缓解效果优于枕骨区域的疼痛缓解效果。 (C) 2014 Elsevier B.V. 保留所有权利。
Background: The role for spinal cord stimulation (SCS) in the management of chronic spinal cord forms of pain involving cervical dermatomes or the cervicomedullary junction (CMJ) for facial pain remains largely uncharted.Objective: To review outcomes with cervical and CMJ SCS performed by a single surgeon, with particular emphasis on complications and efficacy.Methods: All patients that underwent cervical or CMJ SCS by the lead author were identified and follow-up obtained by telephone questionnaires. Patient demographics, surgical details, outcomes and complications for all patients identified were critically reviewed.Results: Of 121 patients identified that underwent at least trial SCS, 100 underwent permanent lead implantation. Indications for cervical SCS included brachial plexus lesions (8), complex regional pain syndrome (33), degenerative disc disease (4), failed neck surgery syndrome (23), chronic radiculopathy (6) and post-herpetic neuralgia (PHN) (1); for CMJ SCS, indications included trigeminal deafferetiation pain (10), trigeminal neuropathic pain (4), PHN (4) and occipital neuralgia (7). Pain relief was greater along the extremities than axially, and less in the occipital area than in the head or face. Mean pain reduction averaged 56.6% at a mean follow-up of 4.2 years. Of 24 revision surgeries required, 8 were for presumed lead migration or fracture. Complications included 4 CSF leaks, 5 wound infections, and 4 cases of persistent numbness or pain. Pain relief lasted an average of 3.6 years.Conclusion: Cervical and CMJ SCS are safe and efficacious and may provide greater relief along the upper extremities than axially, and in the head rather than in the occipital region. (C) 2014 Elsevier B.V. All rights reserved.