Aló Kenneth M, Holsheimer Jan
Pain and Health Management Center, P.A. Houston, Texas 77090, USA.
Neurosurgery. 2002 Apr;50(4):690-703; discussion 703-4. doi: 10.1097/00006123-200204000-00003.
Since its first application in 1967, the methodology and technology of spinal cord stimulation for the management of chronic, intractable pain have evolved continuously. Despite these developments and improved knowledge of the effects of spinal anatomy and epidural contact configuration on paresthesia coverage, the clinical results of spinal cord stimulation-particularly the long-term effects-are still unsatisfactory in many patients. This dissatisfaction has come primarily from the failure of single-electrode configurations to provide consistent paresthesia coverage of the entire painful area. Therefore, new approaches were developed during the late 1990s that attempted to selectively cover one or more dermatomes with paresthesia as well as to provide sequential stimulation of different anatomic sites. These approaches have been applied both intraspinally and extraspinally by stimulating either the spinal nerves or the dorsal columns. To target parts of the latter, different methods have been developed and tested using either two-dimensional contact configurations or electronic field steering. These developments hold promise for improving long-term outcomes as well as increasing the number of pain conditions that can be treated with neuromodulation therapy. In this review, the history, theoretical basis, and evolution of these methodologies, as well as the ways in which they represent new trends in neuromodulation, are discussed.
自1967年首次应用以来，脊髓刺激技术用于治疗慢性顽固性疼痛的方法和技术一直在不断发展。尽管有这些进展，并且对脊髓解剖结构和硬膜外接触配置对感觉异常覆盖范围的影响有了更深入的了解，但脊髓刺激的临床效果——尤其是长期效果——在许多患者中仍然不尽人意。这种不满主要源于单电极配置无法始终如一地覆盖整个疼痛区域的感觉异常。因此，在20世纪90年代后期开发了新的方法，试图选择性地覆盖一个或多个皮节的感觉异常，并对不同的解剖部位进行顺序刺激。这些方法已通过刺激脊神经或背柱在脊髓内和脊髓外应用。为了针对后者的部分区域，已经开发并测试了使用二维接触配置或电场控制的不同方法。这些进展有望改善长期疗效，并增加可通过神经调节疗法治疗的疼痛病症的数量。在这篇综述中，将讨论这些方法的历史、理论基础和演变，以及它们代表神经调节新趋势的方式。
