Dupré Derrick A, Tomycz Nestor, Whiting Donald, Oh Michael
Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, U.S.A.
Pain Pract. 2018 Apr;18(4):500-504. doi: 10.1111/papr.12639. Epub 2017 Nov 20.
Despite requiring successful trials prior to implantation, spinal cord stimulation (SCS) systems for pain are often later removed. Removing surgically implanted hardware subjects patients to the risks and discomfort of a second surgery, threatens the cost-effectiveness of SCS, and limits the perceived durability of SCS technology for pain problems.
To investigate patterns of reasons given among patients who underwent SCS explant surgery (SCSES).
Retrospective review of SCSES cases over 17 years at Allegheny General Hospital, Pittsburgh, PA.
165 patients underwent SCSES between 1997 and 2014. The top 3 reasons for explantation were inadequate pain control (IPC; 73%), hardware discomfort (22%), and need for magnetic resonance imaging (MRI) (10%). Other less frequent reasons were infection (9%), painful dysesthesias (9%), electrical arcing (4%), resolution of inciting symptoms (4%), weakness (2%), pseudomeningocele (1%) and muscle spasms (1%).
Inadequate pain control is the most common reason for SCSES. Advances in technology are needed to improve the quality and duration of pain control, as well as to design improvements to make the hardware more comfortable. A significant number of implants are removed due to need for MRI, a fact obviating the need for MRI-compatible systems. Patients considering SCS paddle lead placement should be counseled on the most common reasons for later explantation.
尽管脊髓刺激（SCS）疼痛治疗系统在植入前需要成功的试验，但这些系统后期常常被移除。移除手术植入的硬件会使患者面临二次手术的风险和不适，威胁到SCS的成本效益，并限制了SCS技术在疼痛问题上的耐用性。
调查接受SCS取出手术（SCSES）的患者给出的原因模式。
回顾性分析宾夕法尼亚州匹兹堡阿勒格尼综合医院17年间的SCSES病例。
1997年至2014年间有165例患者接受了SCSES。取出的前三大原因是疼痛控制不足（IPC；73%）、硬件不适（22%）和需要进行磁共振成像（MRI）检查（10%）。其他不太常见的原因包括感染（9%）、疼痛性感觉异常（9%）、电弧（4%）、激发症状缓解（4%）、虚弱（2%）、假性脑脊膜膨出（1%）和肌肉痉挛（1%）。
疼痛控制不足是SCSES最常见的原因。需要技术进步来提高疼痛控制的质量和持续时间，以及设计改进以使硬件更舒适。相当数量的植入物因需要进行MRI检查而被取出，这一事实消除了对MRI兼容系统的需求。对于考虑植入SCS片状电极的患者，应就后期取出的最常见原因进行咨询。
