Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Neuromodulation. 2011 Mar-Apr;14(2):130-4; discussion 134-5. doi: 10.1111/j.1525-1403.2010.00319.x. Epub 2010 Dec 13.
Patients will typically undergo awake surgery for permanent implantation of spinal cord stimulation (SCS) in an attempt to optimize electrode placement using patient feedback about the distribution of stimulation-induced paresthesia. The present study compared efficacy of first-time electrode placement under awake conditions with that of neurophysiologically guided placement under general anesthesia.
A retrospective review was performed of 387 SCS surgeries among 259 patients which included 167 new stimulator implantation to determine whether first time awake surgery for placement of spinal cord stimulators is preferable to non-awake placement.
The incidence of device failure for patients implanted using neurophysiologically guided placement under general anesthesia was one-half that for patients implanted awake (14.94% vs. 29.7%).
Non-awake surgery is associated with fewer failure rates and therefore fewer re-operations, making it a viable alternative. Any benefits of awake implantation should carefully be considered in the future.
为了优化电极的放置位置，患者通常会在清醒状态下接受永久性脊髓刺激（SCS）的植入手术，以便根据患者对刺激诱发的感觉异常分布的反馈来进行操作。本研究比较了在清醒状态下首次放置电极与在全身麻醉下进行神经生理引导放置的效果。
对 259 名患者的 387 例 SCS 手术进行了回顾性分析，其中包括 167 例新的刺激器植入，以确定首次清醒手术是否优于非清醒手术。
在全身麻醉下进行神经生理引导下放置脊髓刺激器的患者，设备故障的发生率是清醒手术患者的一半（14.94%比 29.7%）。
非清醒手术与较低的失败率相关，因此较少需要再次手术，是一种可行的替代方法。未来应慎重考虑清醒植入的任何优势。
