Barolat G, Schwartzman R, Woo R
Department of Neurosurgery, Jefferson Medical College, Philadelphia, Pa.
Stereotact Funct Neurosurg. 1989;53(1):29-39. doi: 10.1159/000099515.
Eighteen subjects with intractable pain due to reflex sympathetic dystrophy (RSD) underwent treatment by epidural spinal cord stimulation (SCS). All the patients had previously undergone multiple sympathetic blocks and/or surgical sympathectomy with either no results or only temporary therapeutic effects. Four subjects did not experience any beneficial effects during a 1-week trial and the electrode was removed, and 14 patients had the system internalized surgically. In 4 cases two separate systems (electrode + pulse generator) were implanted, in order to cover distant areas of the body involved by the disease (neck, shoulders, upper extremities, trunk and lower extremities). Follow-up varies from 4 to 14 months. In the implanted group, pain relief was absent in 3 patients, minimal in 1, moderate in 5 and good in 6. Pain relief was strictly limited to the body parts covered by the parasthesiae induced by SCS. In 3 patients, SCS produced visible changes in the swelling of the painful extremities. None of the patients was made neurologically worse. In 7 patients there were technical problems related to electrode breakage or migration, change in the pattern of paresthesiae and poor connection due to body fluid infiltration. All the problems were corrected surgically under local anesthesia. SCS has some value in the management of refractory RSD pain in selected cases. Because of the limited series and follow-up, its value in the comprehensive management of RSD requires further investigation.
18例因反射性交感神经营养不良（RSD）导致顽固性疼痛的患者接受了硬膜外脊髓刺激（SCS）治疗。所有患者此前均接受过多次交感神经阻滞和/或手术交感神经切除术，但均无效果或仅有短暂的治疗效果。4例患者在1周的试验期间未体验到任何有益效果，电极被移除，14例患者通过手术将系统植入体内。在4例患者中，植入了两个独立的系统（电极+脉冲发生器），以覆盖疾病累及的身体远处部位（颈部、肩部、上肢、躯干和下肢）。随访时间为4至14个月。在植入组中，3例患者疼痛未缓解，1例患者疼痛缓解轻微，5例患者疼痛缓解中等，6例患者疼痛缓解良好。疼痛缓解严格局限于SCS诱导的感觉异常所覆盖的身体部位。3例患者中，SCS使疼痛肢体的肿胀出现明显变化。没有患者的神经功能恶化。7例患者存在与电极断裂或移位、感觉异常模式改变以及因体液浸润导致连接不良相关的技术问题。所有问题均在局部麻醉下通过手术得到纠正。SCS在某些选定病例中对难治性RSD疼痛的治疗具有一定价值。由于病例数有限且随访时间较短，其在RSD综合治疗中的价值需要进一步研究。
