Department of Neurosurgery, Harvey Cushing Institute of Neurosciences, Hofstra University School of Medicine and North Shore University Hospital, Manhasset, New York, USA.
Neurosurgery. 2012 Jun;70(2 Suppl Operative):230-6. doi: 10.1227/NEU.0b013e318232ff29.
Placement of spinal cord stimulating paddle leads has traditionally been performed under local anesthesia with intravenous sedation to allow intraoperative confirmation of appropriate placement. It may be difficult to maintain appropriate sedation in certain patients because of medical comorbidities. Furthermore, patients undergoing lead revision frequently have extensive epidural scarring, requiring multilevel laminectomies to place the electrode appropriately.
To report our technique of neurophysiologic monitoring that allows these procedures to be performed under general anesthesia.
Data from 78 patients who underwent electromyography during laminectomy for paddle lead placement were retrospectively reviewed. Seventy patients presented for first-time permanent system placement after a successful trial, and 8 were referred for revision or replacement of previously functioning systems. Surgeries were performed under general anesthesia with fluoroscopic guidance. Electromyography was used to help define the physiological midline of the spinal cord and to guide appropriate lead placement. Somatosensory evoked potentials were used as an adjunct to minimize the possibility of neural injury.
Immediately postoperatively, 75 of 78 patients reported that the paresthesia coverage was as good as (or better than) that of the spinal cord stimulation trial. At the long-term follow-up, 1 system was removed for infection, and 6 systems were explanted for lack of efficacy. A total of 64 of the 78 implanted patients reported continued pain relief with stimulator use. Revision surgery was performed in 9 patients.
The use of intraoperative electrophysiology for the placement of spinal cord stimulation paddle leads under general anesthesia is a safe and efficacious alternative to awake surgery.
脊髓刺激片电极的放置传统上是在局部麻醉下进行的，同时给予静脉镇静，以允许在术中确认适当的放置。由于医疗合并症，某些患者可能难以维持适当的镇静。此外，接受导丝修订的患者通常有广泛的硬膜外瘢痕，需要进行多节段椎板切除术以适当放置电极。
报告我们的神经生理监测技术，使这些程序可以在全身麻醉下进行。
回顾性分析了 78 例在进行片电极放置椎板切除术时接受肌电图检查的患者的数据。70 例患者在成功进行试验后首次接受永久性系统放置，8 例患者因先前功能系统的修订或更换而就诊。手术在全身麻醉下进行，辅以透视引导。肌电图用于帮助确定脊髓的生理中线，并指导适当的电极放置。体感诱发电位用作辅助手段，以最大程度地减少神经损伤的可能性。
78 例患者中有 75 例在术后立即报告说，感觉异常的覆盖范围与（或优于）脊髓刺激试验的覆盖范围一样好。在长期随访中，1 个系统因感染而被移除，6 个系统因缺乏疗效而被取出。78 例植入患者中有 64 例报告继续使用刺激器缓解疼痛。9 例患者进行了修订手术。
在全身麻醉下使用术中电生理学进行脊髓刺激片电极的放置是一种安全有效的替代清醒手术的方法。
