St. Maartenskliniek, Nijmegen, The Netherlands.
Neuromodulation. 2013 May-Jun;16(3):244-50; discussion 249-50. doi: 10.1111/j.1525-1403.2012.00512.x. Epub 2012 Sep 25.
To investigate whether spinal cord stimulation (SCS) has a negative effect on static balance and gait, which is implicated by the increased incidence of falls leading to frequently occurring lead migrations.
A controlled trial is performed with 11 subjects (four female, seven male) with a mean age of 46 years old. A baseline measurement consisting of static balance and gait tests was performed. Within two weeks after implantation of a spinal cord stimulator, subjects performed the same tests with both stimulation switched on and off. Static balance was assessed with eyes open and eyes closed on hard surface and foam surface. The velocity of the center of pressure and weight symmetry were the main outcome parameters. Kinematics and spatiotemporal outcome parameters were used to analyze gait. ANOVAs were used to compare between baseline, stimulation on, and stimulation off.
Spinal cord stimulation resulted in significant pain relief as scored on a Visual Analog Scale (p < 0.001). Gait width decreased and this change (indicative of improvement in balance) was significant (p = 0.007). No other significant group differences were found between stimulation baseline and post-surgery measurements. SCS did not influence static balance or gait when group effects were analyzed. Four subjects showed significant differences in static balance between stimulation on and off.
The lack of group differences in normal gait and static balance cannot explain the increased incidence of falls. However, four subjects showed an effect of SCS on static balance. Further research to clarify why only a part of the subjects experienced balance problems is recommended and assessments of more demanding balance and gait tasks are desirable.
研究脊髓刺激（SCS）是否会对静态平衡和步态产生负面影响，因为这与跌倒发生率增加有关，而跌倒会导致导丝经常迁移。
对 11 名年龄在 46 岁左右的受试者（4 名女性，7 名男性）进行了一项对照试验。进行了基线测量，包括静态平衡和步态测试。在脊髓刺激器植入后两周内，受试者在刺激开启和关闭两种状态下进行了相同的测试。在硬表面和泡沫表面上睁眼和闭眼评估静态平衡。主要的结果参数是中心压力速度和重量对称性。运动学和时空参数用于分析步态。使用方差分析比较基线、刺激开启和刺激关闭时的结果。
脊髓刺激显著缓解了视觉模拟评分（VAS）上的疼痛（p < 0.001）。步宽减小，这种变化（表明平衡改善）具有统计学意义（p = 0.007）。在刺激基线和手术后测量之间，没有发现其他具有统计学意义的组间差异。当分析组间效应时，SCS 对静态平衡或步态没有影响。有 4 名受试者在刺激开启和关闭时的静态平衡上显示出显著差异。
正常步态和静态平衡方面没有组间差异，这不能解释跌倒发生率增加的原因。然而，有 4 名受试者的 SCS 对静态平衡有影响。建议进一步研究以阐明为什么只有一部分受试者出现平衡问题，并评估更具挑战性的平衡和步态任务。
