Rasche D, Siebert S, Stippich C, Kress B, Nennig E, Sartor K, Tronnier V M
Neurochirurgische Klinik, Universitätsklinikum Heidelberg.
Schmerz. 2005 Nov;19(6):497-500, 502-5. doi: 10.1007/s00482-005-0388-9.
Spinal cord stimulation (SCS) is an effective alternative treatment in patients with chronic neuropathic pain and mainly radicular distribution. The aim of this prospective study was to investigate changes in BOLD signal with fMRI during active SCS and to correlate the results with the clinical pain intensity, measured with a visual analogue scale (VAS).
Three patients with failed back surgery syndrome were tested during the clinical trial of SCS. A first fMRI was performed with marked pain and a high VAS score. Before the second fMRI a therapeutic stimulation phase with pain reduction was carried out.
With high pain levels SCS activated the cingulate gyrus, thalamus, prefrontal cortex, supplementary motor area and postcentral gyrus. After pain reduction, SCS did not elicit these activations in the second fMRI, using the same stimulation parameters.
In patients with chronic neuropathic pain and high VAS levels, SCS elicited BOLD activation in the cingulate gyrus, thalamus, prefrontal cortex, and primary and secondary somatosensory area. Pain reduction by SCS resulted in a reduction of functional activity in these areas as revealed by follow-up fMRI.
脊髓刺激（SCS）是慢性神经性疼痛且主要呈神经根分布患者的一种有效替代治疗方法。这项前瞻性研究的目的是在SCS激活期间通过功能磁共振成像（fMRI）研究血氧水平依赖（BOLD）信号的变化，并将结果与用视觉模拟量表（VAS）测量的临床疼痛强度相关联。
在SCS临床试验期间对3例腰椎手术失败综合征患者进行了测试。首次fMRI检查时患者疼痛明显且VAS评分较高。在第二次fMRI检查前进行了一个疼痛减轻的治疗刺激阶段。
在疼痛程度较高时，SCS激活了扣带回、丘脑、前额叶皮质、辅助运动区和中央后回。疼痛减轻后，使用相同的刺激参数，SCS在第二次fMRI检查中未引发这些激活。
在慢性神经性疼痛且VAS水平较高的患者中，SCS引发了扣带回、丘脑、前额叶皮质以及初级和次级体感区的BOLD激活。后续fMRI显示，SCS减轻疼痛导致这些区域的功能活动减少。
