SPINAL-CORD STIMULATION FOR CHRONIC, INTRACTABLE PAIN - EXPERIENCE OVER 2 DECADES
SPINAL-CORD STIMULATION FOR CHRONIC, INTRACTABLE PAIN - EXPERIENCE OVER 2 DECADES
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DOI：
10.1227/00006123-199303000-00008
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发表时间：
1993-03-01
期刊：
影响因子：
4.8
通讯作者：
YOUNG, RF
中科院分区：
文献类型：
--
作者：
NORTH, RB;KIDD, DH;YOUNG, RF
在过去的二十年里，脊髓刺激装置和技术已经从单通道系统（电极需要椎板切除术）发展到可编程的“多通道”系统（电极可以垂直放置）。我们回顾了1972年至1990年期间在我们机构接受这些器械治疗的320例连续患者的经验。通过单变量和多变量统计方法，治疗的技术细节以及患者特征已被评估为临床结局和硬件可靠性的预测因素。目前，对205例患者进行了术后2 - 20年（平均7.1年）的随访。所有的临床结果测量都是基于第三方访谈数据-标准模拟疼痛评分、就业状况、日常生活活动和镇痛药的使用。在7年平均随访时，171名接受永久性植入物的患者中有52%报告至少50%的疼痛持续缓解。大多数患者的日常生活活动和镇痛药使用情况持续改善。对298个永久性植入物的硬件可靠性分析显示，随着单通道植入物演变为可编程多通道器械，临床故障（P < 0.001）和技术故障（特别是电极移位和错位，P = 0.025）显著减少。我们对技术和临床预后因素的分析可能有助于临床医生选择这种手术的患者。
OVER THE PAST two decades, spinal cord stimulation devices and techniques have evolved from single-channel systems, with electrodes requiring laminectomy, into programmable ''multichannel'' systems with electrodes that may be placed percutaneously. We have reviewed our experience in 320 consecutive patients treated with these devices at our institution between 1972 and 1990. Technical details of treatment as well as patient characteristics have been assessed as predictors of clinical outcome and of hardware reliability by univariate and multivariate statistical methods. Current follow-up has been obtained at intervals from 2 to 20 years (mean, 7.1 yr) post-operatively on 205 patients. All clinical outcome measures have been based on disinterested third-party interview data-standard analog pain ratings, employment status, activities of daily living, and use of analgesics. At 7-year mean follow-up, 52% of the 171 patients who received permanent implants reported at least 50% continued pain relief. A majority had maintained improvements in activities of daily living and analgesic use. Analysis of hardware reliability for 298 permanent implants revealed significantly fewer clinical failures (P < 0.001) and technical failures (in particular, electrode migration and malposition, P = 0.025) as single-channel implants have evolved into programmable, multichannel devices. Our analysis of technical and clinical prognostic factors may be useful to the clinician in selecting patients for this procedure.