Bunch Jennifer R, Goldstein Heidi V, Hurley Robert W
Department of Anesthesiology, University of Florida, Gainesville, FL, U.S.A.
Pain Pract. 2015 Jan;15(1):E20-6. doi: 10.1111/papr.12226. Epub 2014 Jun 12.
Spinal cord stimulator (SCS) technology has advanced over the past several years. However, our literature review revealed a lack of well-documented cases of successful treatment of phantom limb pain with percutaneous revision of previously placed systems.
We present the case of a patient who suffered from debilitating bilateral lower extremity phantom limb pain despite having a SCS with a constant voltage system. We used fluoroscopy to successfully guide a percutaneous octapolar paddle lead to the right of the existing surgical paddle lead and a cylindrical quadrapolar lead in between. Finally, the older paddle lead was connected to an extension to make it compatible with the updated constant current system. The revised constant current SCS system provided bilateral coverage of the patient's pain, and at 1-year postoperative, the patient reported he had sustained coverage from his bilateral phantom limb pain. Our patient had complete coverage of his phantom limb pain after his previously placed SCS was changed from a constant voltage to a constant current system, and percutaneous leads were connected to his system. Adding percutaneous leads or switching generator types may benefit patients whose pain patterns have expanded since original SCS system placement. This case reports the complete coverage of phantom limb pain with a change from a constant voltage to a constant current SCS system and the addition of percutaneous leads to an existing SCS system.
脊髓刺激器（SCS）技术在过去几年中有了进步。然而，我们的文献综述显示，缺乏关于经皮修订先前放置的系统成功治疗幻肢痛的充分记录案例。
我们报告一例患者，尽管其拥有恒压系统的脊髓刺激器，但仍遭受双侧下肢严重幻肢痛。我们使用荧光透视成功地将一个经皮八极片状电极引导至现有手术片状电极右侧，并在两者之间放置一个圆柱形四极电极。最后，将较旧的片状电极连接到延长线上，使其与更新后的恒流系统兼容。修订后的恒流SCS系统为患者的疼痛提供了双侧覆盖，术后1年，患者报告其双侧幻肢痛持续得到缓解。在将患者先前放置的SCS从恒压系统改为恒流系统并连接经皮电极后，患者的幻肢痛得到了完全缓解。对于自最初放置SCS系统以来疼痛模式有所扩展的患者，增加经皮电极或更换发生器类型可能有益。本病例报告了通过将恒压SCS系统改为恒流SCS系统以及在现有SCS系统中增加经皮电极，幻肢痛得到完全缓解的情况。
