脊髓电刺激电极实际放置位置与理论靶点偏移的真实世界研究*

A Real-World Study on the Deviation Between Actual Electrode Placement Position and Theoretical Target in Spinal Cord Stimulation*

摘要:

目的：基于真实世界脊髓电刺激(spinal cord stimulation, SCS)病例,观察实际电极放置位置与理论靶点位置的偏移情况和可能因素。方法：选取2018～2023年于中日友好医院疼痛科行SCS治疗的住院病人144例。记录病人的性别、年龄、体重、BMI值、诊断、疼痛部位、术前术后视觉模拟评分法(visual analogue scale, VAS)评分和电极理论靶点与实际放置位置的偏移量。对偏移量进行可视化分析,观察其分布情况,并根据偏移量将病人分为两组,比较两组病人的上述指标。结果：①靶点位于C3～T8水平时,电极实际放置位置较靶点下移更为普遍,靶点位于T9～L1节段时电极实际放置位置较靶点上移的情况较多；②疼痛位于手部、胸腹部、会阴部的病例出现电极位点较靶点下移的情况较多,其中手部病变电极偏移最为明显；而上肢、下肢及足部电极实际位点较靶点上移趋势明显；③不同偏移程度组年龄、BMI、病程、VAS%均未见显著差异(P> 0.05)。结论：脊髓电刺激电极的实际放置位置在上胸段易向下偏移,在胸腰段易向上偏移,偏移量不超过1个椎体。

Abstract:

Objective: To investigate the deviation between actual electrode placement and theoretical target positions in spinal cord stimulation (SCS) based on real-world cases, and explore potential influencing factors. Methods: A total of 144 inpatients who underwent SCS therapy in the Pain Department of China-Japan Friendship Hospital between 2018 and 2023 were included. Data on gender, age, weight, BMI, diagnosis, pain location, pre- and postoperative visual analogue scale (VAS) scores, and the deviation between theoretical target and actual electrode placement positions were recorded. The deviations were visualized to analyze their distribution patterns. Patients were divided into two groups based on deviation direction, and the above variables were compared between groups. Results: ①When the target was at the C3～T8 levels, the actual electrode placement position tended to shift caudally (downward) relative to the target, whereas at the T9～L1 segments, a cranial (upward) shift was more common. ②Cases with pain in the hands, thoracoabdominal region, or perineum exhibited more frequent caudal electrode deviations, with the most pronounced shifts observed in hand-related conditions. In contrast, pain in the upper limbs, lower limbs, and feet showed a clear trend of cranial electrode deviation. ③No significant differences were found between groups in age, BMI, disease duration, or VAS% improvement (P> 0.05). Conclusion: In SCS, electrode placement tends to shift caudally in the upper thoracic spine and cranially in the thoracolumbar region, with deviations generally within one vertebral level.