North Richard B, Ewend Matthew G, Lawton Michael T, Piantadosi Steven
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MDU.S.A. Department of Biostatistics, Johns Hopkins University School of Medicine, Baltimore, MDU.S.A.
Pain. 1991 Feb;44(2):119-130. doi: 10.1016/0304-3959(91)90125-H.
Spinal cord stimulation has evolved over the past 20 years into an easily implemented technique, with low morbidity, for the treatment of intractable, chronic pain in properly selected patients. We report our experience with a series of 62 patients implanted between 1983 and 1987, with percutaneous and laminectomy electrodes, and with single- and "multi-channel" (programmable, multi-contact) devices. Fifty had chronic, intractable low back and leg pain ("failed back surgery syndrome," lumbar arachnoid fibrosis), five had spinal cord injuries, and seven "peripheral" pathology or stump pain. Statistical analysis of these and other patient characteristics and technical factors was undertaken to identify predictors of outcome. All patients were interviewed by a disinterested third party at a mean of 2.14 years following implantation. A majority of patients reported at least 50% sustained relief of pain and indicated that they would go through the procedure again for the same result. There was corresponding improvement in ability to perform various everyday activities, and decrease in use of analgesics. Ten of 40 failed back patients who were disabled before the procedure returned to work postoperatively. Superposition of stimulation paresthesias upon a patient's topography of pain was found to be a statistically significant predictor of successful relief of pain, by linear regression methods. Univariate and multivariate analysis of patient characteristics and technical factors as predictors of outcome demonstrated significant advantages for female patients, and for patients implanted with "multi-channel" devices. With these devices, electrode geometries with central cathode(s) flanked by rostral and caudal anode(s) were favored disproportionately. Technical improvements in implanted spinal cord stimulation devices, in particular the development of multi-contact percutaneous electrode arrays and supporting programmable electronics, have significantly improved clinical results.
在过去20年中，脊髓刺激已发展成为一种易于实施、发病率低的技术，用于治疗经适当选择的患者的顽固性慢性疼痛。我们报告了1983年至1987年间植入的62例患者的经验，这些患者使用了经皮和椎板切除术电极，以及单通道和“多通道”（可编程、多触点）装置。50例患有慢性顽固性腰腿痛（“腰椎手术失败综合征”、腰椎蛛网膜纤维化），5例患有脊髓损伤，7例患有“周围性”病变或残端疼痛。对这些以及其他患者特征和技术因素进行了统计分析，以确定结果的预测因素。所有患者均由一名无利害关系的第三方在植入后平均2.14年进行访谈。大多数患者报告疼痛持续缓解至少50%，并表示为了同样的结果他们愿意再次接受该手术。在进行各种日常活动的能力方面有相应改善，并且镇痛药的使用减少。40例腰椎手术失败且术前残疾的患者中有10例术后重返工作岗位。通过线性回归方法发现，刺激感觉异常叠加在患者疼痛部位上是疼痛成功缓解的统计学显著预测因素。对患者特征和技术因素作为结果预测因素的单变量和多变量分析表明，女性患者以及植入“多通道”装置的患者具有显著优势。对于这些装置，中央阴极两侧为头侧和尾侧阳极的电极几何形状得到了不成比例的青睐。植入式脊髓刺激装置的技术改进，特别是多触点经皮电极阵列和支持可编程电子设备的开发，显著改善了临床结果。
