脊髓电刺激治疗脊柱外伤后神经病理性疼痛临床研究

CLINICAL STUDY OF SPINAL CORD STIMULATION IN THE TREATMENT OF NEUROPATHIC PAIN AFTER SPINE INJURY

摘要:

【摘要】目的：研究脊柱外伤后慢性神经病理性疼痛（neuropathic pain, NP）患者采用脊髓电刺激（spinal cord stimulation, SCS）治疗的长期疗效和并发症，探讨不同脊柱损伤节段和疼痛区域感觉缺失程度与SCS疗效相关性。方法：回顾性分析采用SCS治疗的脊柱外伤后慢性NP患者19例。将一期测试效果不佳和二期植入脉冲发生器后随访效果不佳的患者归入无效组；余患者归入有效组。比较不同脊柱损伤节段和疼痛区域感觉缺失程度与疗效间有无统计学差异。结果：19例患者中，SCS测试效果不佳7例；12例植入脉冲发生器患者中，3例后期随访疼痛控制不佳，9例长期有效患者平均疼痛改善率为79.7%。L1以下损伤患者8例，有效5例；L1及以上损伤11例，有效4例。14例疼痛区域感觉减退患者有9例SCS治疗长期有效；5例感觉缺失患者SCS测试全部无效。按L1水平区分脊柱损伤部位与SCS疗效无统计学差异；疼痛区域感觉减退程度与SCS疗效存在统计学差异。结论：针对脊柱外伤后慢性NP患者，疼痛区域感觉减退不是SCS治疗的禁忌症，疼痛区域感觉缺失的患者不建议SCS治疗。单纯马尾神经损伤或脊髓合并神经根损伤都可能从SCS治疗中获益。

Abstract:

[Abstract] Objective: To investigate the long-term efficacy and complications of spinal cord stimulation (SCS) in patients with neuropathic pain (NP) after spine injury, and to explore whether the degree of sensory loss in pain territory and spinal injury segment are related to the efficacy of SCS. Methods: 19 patients with chronic NP after spine injury treated by SCS were analyzed retrospectively. The patients with poor results of the first phase screening test and the follow-up after the second phase implantation of the pulse generator were classified into the ineffective group and the rest into the effective group. To compare the degree of hypoesthesia and different spine injury segment with the curative effect. Results: among the 19 patients, 7 had poor effect of SCS screening test; among the 12 patients implanted with pulse generator, 3 had poor pain control in follow-up, and the average pain improvement rate of the remaining 9 patients with long-term effect was 79.7%. There were 8 patients with injury below L1 segment, of whom 5 received good long-term effect; 11 patients with injury above L1 segment, of whom 4 had good long-term effect. Among the 14 patients with hypoesthesia in pain territory, 9 had good long-term effect of SCS, the SCS test of 5 patients with sensory loss was invalid. There was no significant difference between the effect of SCS and that of the spinal injury segment; there was significant difference between the effect of SCS and the degree of sensory loss. Conclusion: for patients with neuropathic pain after spine injury, hypoesthesia within pain territory is not the contraindication of SCS, but it is not recommended for the patients with pain area sensory loss. Both cauda equina injury and spinal cord combined nerve root injury may benefit from SCS.