Acta Neurochir (Wien). 2013 Dec;155(12):2327-32. doi: 10.1007/s00701-013-1885-8.
Spinal cord stimulation (SCS) is an accepted treatment in patients with failed back surgery (FBS), complex regional pain syndrome (CRPS) and persistent radicular pain following surgery. In order to avoid patient hazards or device malfunction manufacturers advise to abstain from magnetic resonance imaging (MRI) in patients with implanted electrodes or pulse generators.
In a prospective study, 13 patients harbouring an implanted Medtronic Spinal Cord Stimulation (SCS) device underwent MRI (1.5 T) of the lumbar (n=13), the cervical (n=2) or the thoracic spine (n=1) following the development of new spinal symptoms. An adapted MRI protocol was used limiting the transmitted energy and specific absorption rate. Tolerability and safety were assessed by means of a standardized patient evaluation form documenting pain on a visual analogue scale (0-10), neurologic deficit, and discomfort during the scan. In addition, overall satisfaction with the examination procedure was rated on a Likert scale (1-5). Image quality was rated independently and blinded to the presence of a SCS device by the radiologist and the surgeon as equivalent, superior or inferior compared to the standard spine MRI examination.
None of the 13 patients investigated by the modified spinal MRI protocol experienced new neurological deficits, worsening of symptoms or a defect/malfunction of the implant device. Three patients (23.1 %) reported transient warm sensation in the location of the electrode and in one case intermittent slight tingling in the lower extremities. Overall satisfaction with the examination was 1.13 ± 0.34 according to Likert scale (1-5). The image quality was rated - not statistically significant - slightly inferior to standard lumbar spine imaging (0.82 ± 0.54) with a kappa value of 0.68 between the two investigators. MRI examinations detected relevant and new lesions in 9 (69.2 %) patients which affected treatment in 8 (61.5 %) individuals.
Using a protocol with a reduced specific energy absorption rate, spinal MRI examinations in patients with SCS can be considered safe. The current view that neurostimulators are a general contraindication to MR examinations has to be reconsidered in patients with new or progressive spinal symptoms.
脊髓刺激 (SCS) 是治疗失败的背部手术 (FBS)、复杂区域疼痛综合征 (CRPS) 和手术后持续性神经根痛患者的一种公认方法。为了避免患者的危险或设备故障，制造商建议避免对植入电极或脉冲发生器的患者进行磁共振成像 (MRI)。
在一项前瞻性研究中，13 名植入了美敦力脊髓刺激 (SCS) 设备的患者在出现新的脊髓症状后，接受了腰椎 (n=13)、颈椎 (n=2) 或胸椎 (n=1) 的 MRI(1.5 T)。使用了一种适应性的 MRI 协议，限制了传输能量和比吸收率。通过记录视觉模拟量表 (0-10) 上的疼痛、神经功能缺损和扫描过程中的不适程度的标准化患者评估表，评估了可耐受性和安全性。此外，还使用 Likert 量表 (1-5) 对检查程序的总体满意度进行了评分。放射科医生和外科医生独立且对 SCS 设备的存在进行了盲法评估，对图像质量进行了评估，结果显示与标准脊柱 MRI 检查相当、更优或更差。
在接受改良脊柱 MRI 检查的 13 名患者中，没有一人出现新的神经功能缺损、症状加重或植入设备的缺陷/故障。3 名患者 (23.1%) 报告电极部位出现短暂的温热感，1 名患者下肢间歇性出现轻微刺痛。根据 Likert 量表 (1-5)，检查的总体满意度为 1.13±0.34。图像质量的评分-无统计学意义-略低于标准腰椎成像 (0.82±0.54)，两位观察者之间的 Kappa 值为 0.68。9 名患者 (69.2%) 的 MRI 检查检测到相关和新的病变，8 名患者 (61.5%) 的病变影响了治疗。
使用比吸收率降低的协议，SCS 患者的脊柱 MRI 检查可以被认为是安全的。对于出现新的或进展性脊髓症状的患者，必须重新考虑神经刺激器是否为磁共振检查的一般禁忌证。
