Weigel Ralf, Capelle Hans-Holger, Krauss Joachim K
Department of Neurosurgery, University Hospital Mannheim, Germany.
J Neurosurg. 2008 May;108(5):921-5. doi: 10.3171/JNS/2008/108/5/0921.
Stimulation of dorsal nerve roots or dorsal root ganglia was reported to alleviate neuropathic pain in selected patients during the early postoperative period. A prospective study was initiated to investigate long-term outcome in patients with neuropathic pain of the lower extremities or groin who were treated with selective nerve root stimulation.
The study included patients with dermatomally distributed neuropathic pain who were > 18 years of age and in whom the pain was refractory to medical treatment. The patients were prospectively evaluated using a visual analog scale (VAS) for pain and ratings for quality of life, activities of daily living, and depression preoperatively, and after defined intervals postoperatively. Implantation of electrodes was performed via foraminotomy or interlaminar fenestration in an awake procedure. An implantable pulse generator (IPG) was implanted in a second operation after successful test stimulation performed over several days.
Three patients were included in the study before it was stopped. The mean maximum pain score preoperatively was 9.3. All patients had successful test stimulation with > 50% pain relief prior to implantation of the IPG (mean maximum VAS Score 3.6). The beneficial effect, however, was lost within the next few months despite adjustment of stimulation settings. With higher amplitudes, side effects such as pain attacks or motor phenomena occurred. They disappeared after stopping stimulation, but neuropathic pain recurred to its full extent. The study was stopped 18 months after the first implantation, when the third and last IPG of this series was explanted. Due to the overall short-term effect of stimulation, no relevant changes in ratings for quality of life, activities of daily living, or depression were detected.
Spinal nerve root stimulation proved to be effective on short-term follow-up in 3 patients with neuropathic pain in a dermatomal distribution. Long-term stimulation, however, was disappointing because of the loss of effectiveness and the occurrence of side effects.
据报道，刺激背神经根或背根神经节可在术后早期缓解部分患者的神经性疼痛。本研究旨在对接受选择性神经根刺激治疗的下肢或腹股沟神经性疼痛患者的长期疗效进行调查。
本研究纳入年龄大于18岁、药物治疗无效的皮节分布性神经性疼痛患者。术前及术后特定时间间隔，采用视觉模拟评分法（VAS）对患者的疼痛程度、生活质量、日常生活活动能力及抑郁状况进行前瞻性评估。电极植入在清醒状态下通过椎间孔切开术或椎板间开窗术进行。在成功进行数天的测试刺激后，二期手术植入植入式脉冲发生器（IPG）。
在研究终止前共纳入3例患者。术前平均最大疼痛评分为9.3。所有患者在植入IPG前测试刺激均成功，疼痛缓解超过50%（平均最大VAS评分为3.6）。然而，尽管调整了刺激参数，这种有益效果在接下来的几个月内消失。随着刺激幅度增加，出现了疼痛发作或运动现象等副作用。停止刺激后副作用消失，但神经性疼痛又完全复发。在首次植入18个月后，随着本系列最后一台也是第三台IPG被取出，研究终止。由于刺激的总体短期效果，未发现生活质量、日常生活活动能力或抑郁评分有相关变化。
对于3例皮节分布性神经性疼痛患者，脊髓神经根刺激在短期随访中显示有效。然而，长期刺激令人失望，因为出现了疗效丧失和副作用。
