Akbaş Mert, Yeğin Mehmet Arif, Özdemir İrem, Göksu Ethem, Akyüz Mahmut
Department of Anaesthesiology, Division of Algology, Akdeniz University Faculty of Medicine, Antalya, Turkey.
Department of Neurosurgery, Akdeniz University Faculty of Medicine, Antalya, Turkey.
Agri. 2016 Jan;28(1):49-53. doi: 10.5505/agri.2014.91259.
Spinal cord stimulation as treatment of chronic low back pain via neuromodulation has been frequently performed in recent years. The dorsal column is stimulated by an electrode placed at the epidural region. In the case presently described, subcutaneous lead was implanted in a patient with failed back syndrome after spinal cord stimulation was inadequate to treat back and gluteal pain. A 65-year-old male had undergone surgery to treat lumbar disc herniation, after which he received physical therapy and multiple steroid injections due to unrelieved pain. He was admitted to the pain clinic with pain radiating to right gluteal muscle and leg. Spinal cord stimulation was performed and, as pain was not relieved, subcutaneous lead was applied to the right cluneal nerve distribution. Following treatment, the patient scored 1-2 on visual analog scale. Pain had been reduced by over 80%. Octad electrode was placed between T8 and T10 vertebrae after Tuohy needle was introduced to intervertebral area between L1 and L2. Paresthesia occurred in the right extremity. Boundaries were determined by area of right gluteal region in which paresthesia did not occur. Octad electrode was placed subcutaneously after vertical line was drawn from center point. Paresthesia occurred throughout the region. Pulse wave was 390-450 msec; frequency was 10-30 Hz. Subcutaneous electrode replacement is effective additional therapy when pain is not relieved by spinal cord stimulation.
近年来，脊髓刺激作为一种通过神经调节治疗慢性下腰痛的方法已被频繁应用。将电极置于硬膜外区域刺激背柱。在本病例中，一名患有背部手术失败综合征的患者，在脊髓刺激不足以治疗背部和臀部疼痛后，植入了皮下导联。一名65岁男性接受了腰椎间盘突出症手术，术后因疼痛未缓解接受了物理治疗和多次类固醇注射。他因疼痛放射至右臀肌和腿部而入住疼痛诊所。进行了脊髓刺激，但疼痛未缓解，遂将皮下导联应用于右臀上皮神经分布区。治疗后，患者视觉模拟评分1 - 2分。疼痛减轻了80%以上。在将Tuohy针插入L1和L2之间的椎间区域后，将八触点电极置于T8和T10椎骨之间。右侧肢体出现感觉异常。通过未出现感觉异常的右臀区域确定边界。从中心点画出垂直线后，将八触点电极皮下植入。整个区域出现感觉异常。脉冲波为390 - 450毫秒；频率为10 - 30赫兹。当脊髓刺激不能缓解疼痛时，皮下电极置换是一种有效的辅助治疗方法。
