Neurophysiological evidence of antidromic activation of large myelinated fibres in lower limbs during spinal cord stimulation
Neurophysiological evidence of antidromic activation of large myelinated fibres in lower limbs during spinal cord stimulation
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DOI：
10.1097/brs.0b013e3181642a97
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发表时间：
2008-02-15
期刊：
影响因子：
3
通讯作者：
Barolat, Giancarlo
中科院分区：
文献类型：
--
作者：
Buonocore, Michelangelo;Bonezzi, Cesare;Barolat, Giancarlo
研究设计.本研究旨在验证脊髓刺激（SCS）过程中沿着外周感觉神经行进的纤维的恒定逆向激活的假设。研究脊髓刺激（SCS）过程中外周感觉神经记录电位的神经生理学特征（潜伏期、振幅、波形）。SCS被广泛用于缓解对保守治疗有抵抗力的慢性良性疼痛，但其镇痛机制尚不清楚。外周神经纤维的逆向激活是假设的镇痛机制之一，但很少有神经生理学研究已经进行了这一主题。入组了16例接受经皮SCS测试试验治疗下肢慢性疼痛的患者（4例男性，12例女性，平均年龄54.2岁，年龄范围41-77岁）。诊断包括：背部手术失败综合征、I型复杂性区域疼痛综合征、疼痛性腰骶神经根病和疼痛性周围神经病。所有患者均在T9-T12椎体水平的硬膜外腔中植入了电极导线。神经动作电位一般记录在nonpainful腿，但当疼痛是调查的神经领土之外，双边记录进行。对16例患者进行了21项不同的研究。结果证实了皮肤传入神经被SCS定期激活的假设。结论。作者假设这种逆向激活可能代表了周围神经性疼痛患者SCS的一种可能镇痛机制，但需要进一步的神经生理学研究来阐明这一假设。
Study Design. This study was designed to verify the hypothesis of a constant, antidromic activation of fibers traveling along peripheral sensory nerves during spinal cord stimulation (SCS).Objective. To investigate the neurophysiological characteristics (latency, amplitude, waveform) of potentials recorded in peripheral sensory nerves during the SCS.Summary of Background Data. SCS is widely used for the relief of chronic benign pain resistant to conservative therapies, but its antalgic mechanism is poorly understood. Antidromic activation of peripheral nerve fibers is one of the hypothesized antalgic mechanisms, but very few neurophysiological studies have been conducted on this subject.Methods. Sixteen patients undergoing a percutaneous test trial of SCS for chronic pain in the lower limb (4 males, 12 females, mean age of 54.2, and age range 41-77 years) were enrolled. Diagnoses included: failed back surgery syndrome, complex regional pain syndrome type I, painful lumbosacral radiculopathy, and painful peripheral neuropathy. All patients had a lead percutaneously implanted in the epidural space at a vertebral level ranging from T9-T12. Nerve action potentials were generally recorded in nonpainful leg but, when the pain was outside the investigated nerve territory, a bilateral recording was performed. Twenty-one different studies were carried out on 16 patients.Results. The results confirmed the hypothesis that cutaneous afferents were regularly activated by SCS.Conclusion. The authors hypothesize that this antidromic activation could represent a possible antalgic mechanism of SCS in patients with peripheral neuropathic pain, but further neurophysiological studies will be needed to elucidate this hypothesis.