BRAI2N, Department of Neurosurgery, University Hospital Antwerp, 2650 Edegem, Belgium.
Neurosurgery. 2010 May;66(5):986-90. doi: 10.1227/01.NEU.0000368153.44883.B3.
Spinal cord stimulation is commonly used for neuropathic pain modulation. The major side effect is the onset of paresthesia. The authors describe a new stimulation design that suppresses pain as well as, or even better than, the currently used stimulation, but without creating paresthesia.
A spinal cord electrode (Lamitrode) for neuropathic pain was implanted in 12 patients via laminectomy: 4 at the C2 level and 7 at the T8-T9 level for cervicobrachialgia and lumboischialgia, respectively (1 at T11 at another center). During external stimulation, the patients received the classic tonic stimulation (40 or 50 Hz) and the new burst stimulation (40-Hz burst with 5 spikes at 500 Hz per burst).
Pain scores were measured using a visual analog scale and the McGill Short Form preoperatively and during tonic and burst stimulation. Paresthesia was scored as present or not present. Burst stimulation was significantly better for pain suppression, by both the visual analog scale score and the McGill Short Form score. Paresthesia was present in 92% of patients during tonic stimulation, and in only 17% during burst stimulation. Average follow-up was 20.5 months.
The authors present a new method of spinal cord stimulation using bursts that suppress neuropathic pain without the mandatory paresthesia. Pain suppression seems as good as or potentially better than that achieved with the currently used stimulation. Average follow-up after nearly 2 years (20.5 months) suggests that this stimulation design is stable.
脊髓刺激常用于神经病理性疼痛的调节。主要的副作用是出现感觉异常。作者描述了一种新的刺激设计，它可以抑制疼痛，效果与目前使用的刺激一样好，甚至更好，而不会产生感觉异常。
通过椎板切除术在 12 名患者中植入了用于治疗神经病理性疼痛的脊髓电极（Lamitrode）：4 名在 C2 水平，7 名在 T8-T9 水平，分别用于治疗颈臂痛和腰骶痛（另一家中心在 T11 水平有 1 名患者）。在外部刺激期间，患者接受了经典的持续刺激（40 或 50 Hz）和新的爆发刺激（40-Hz 爆发，每个爆发有 5 个 500 Hz 的尖峰）。
使用视觉模拟量表和 McGill 简短形式在术前和持续刺激和爆发刺激期间测量疼痛评分。感觉异常的评分是存在或不存在。爆发刺激在疼痛抑制方面明显优于持续刺激，无论是通过视觉模拟量表评分还是 McGill 简短形式评分。在持续刺激期间，92%的患者出现感觉异常，而在爆发刺激期间，只有 17%的患者出现感觉异常。平均随访时间为 20.5 个月。
作者提出了一种新的脊髓刺激方法，使用爆发刺激来抑制神经病理性疼痛，而无需强制性的感觉异常。疼痛抑制效果与目前使用的刺激一样好，甚至可能更好。近 2 年（20.5 个月）的平均随访表明，这种刺激设计是稳定的。
