Department of Neurosurgery, University of Tennessee, Memphis and Semmes-Murphey Clinic, Memphis, Tennessee.
Neuromodulation. 2003 Jul;6(3):153-7. doi: 10.1046/j.1525-1403.2003.03022.x.
While spinal cord stimulation has commonly been carried out using percutaneous leads, these devices have limitations in cervical implants due to problems with positional stimulation and lead migration. Paddle leads, by virtue of their design, are more stable in their apposition to the neural elements; however, mid and lower cervical insertions have been associated with both acute and subacute spinal cord injuries. These complications are likely related to limitations in canal diameter, as paddle leads occupy a greater volume than percutaneous leads. At C1-C2, the space around the spinal cord is more generous, and thus allows greater room for insertion of leads. We report a series of patients treated with a technique for the implantation of a C1-C2 paddle electrode that capitalizes on this anatomy while still meeting the need for paresthetic overlap in patients with upper extremity pain syndromes. While the technique is not novel, it has not yet been popularized (1). This paper is presented to increase implanters' awareness of the method, its safety and utility. Twenty consecutive patients with neuropathic pain syndromes of the upper extremity were implanted using this technique. Surgical implantation of leads was done under a general anesthetic. An upper cervical incision was used, and after performing minimal laminotomies at C1 and C2, the lead was passed rostro-caudally under direct visualization beneath the lamina. Paresthetic overlap of pain segments was achieved in all but one patient. Pre and postoperative VAS scores were compared to evaluate effectiveness of treatment. Eighteen of 20 patients reported a significant benefit from stimulation, with an average of 63 percent reduction in pain scores. The only complication was a malpositioned lead that required reoperation to adjust placement. No patient suffered neurologic sequelae as a result of this procedure. We have found C1-C2 sublaminar insertions of paddle leads to be a safe and effective way of treating neuropathic pain phenomenon involving the upper extremity. To further assess the relative benefit over percutaneous leads, a prospective trial would be required.
虽然脊髓刺激通常使用经皮导联进行，但这些设备在颈椎植入物中存在局限性，因为存在位置刺激和导联迁移问题。由于其设计，桨式导联在与神经元素的贴合方面更稳定；然而，中颈和下颈插入与急性和亚急性脊髓损伤都有关。这些并发症可能与管腔直径的限制有关，因为桨式导联比经皮导联占据更大的体积。在 C1-C2，脊髓周围的空间更宽敞，因此为导联的插入提供了更大的空间。我们报告了一系列接受 C1-C2 桨式电极植入技术治疗的患者，该技术利用了这种解剖结构，同时仍满足上肢疼痛综合征患者感觉重叠的需要。虽然该技术并不新颖，但尚未普及（1）。本文旨在提高植入者对该方法的认识，包括其安全性和实用性。连续 20 例上肢神经性疼痛综合征患者采用该技术植入。在全身麻醉下进行导联植入手术。采用上颈椎切口，在 C1 和 C2 行最小范围的椎板切开术，在椎板下直接可视化下将导联经颅尾穿过。除了一名患者外，所有患者的疼痛节段均实现了感觉重叠。术前和术后 VAS 评分用于评估治疗效果。20 例患者中有 18 例报告刺激有显著获益，疼痛评分平均降低 63%。唯一的并发症是导联位置不当，需要再次手术调整位置。没有患者因该手术出现神经后遗症。我们发现 C1-C2 下脊索内插入桨式导联是治疗上肢神经性疼痛现象的一种安全有效的方法。为了进一步评估与经皮导联相比的相对益处，需要进行前瞻性试验。
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