Gofeld Michael, Agur Anne
University of Toronto, Toronto, ON, Canada.
Neuromodulation. 2018 Apr;21(3):284-289. doi: 10.1111/ner.12749. Epub 2018 Jan 3.
Although spinal cord and dorsal root ganglia stimulation may be effective for managing regional pain syndromes, a more targeted approach is perhaps more appealing for discrete anatomical structures. Chronic shoulder pain is a common musculoskeletal problem with significant socioeconomic impact. A peripheral nerve stimulation of the axillary and suprascapular nerves may prove to be effective as a long-term solution for this indication. In anticipation of the future experimental research and clinical utilization, a sound methodology for the lead placement was developed, and its feasibility is tested in a cadaveric study.
Normal anatomy was corroborated with ultrasound scans of live models and cadaver specimens. A step-by-step ultrasound-guided implantation technique was designed. The procedure was completed targeting both the axillary and suprascapular nerves. The accuracy of the lead placement was confirmed by dissections.
The implanted devices were found adjacent to the target nerves within 0.5-1 cm distance.
The anatomical dissections confirmed the accuracy of ultrasound-guided placement of the lead. The described method is based on normal anatomy and appeared to be reproducible by following the outlined procedural steps.
尽管脊髓和背根神经节刺激可能对管理局部疼痛综合征有效，但对于离散的解剖结构，更具针对性的方法可能更具吸引力。慢性肩部疼痛是一种常见的肌肉骨骼问题，具有重大的社会经济影响。对腋神经和肩胛上神经进行外周神经刺激可能被证明是该适应症的一种长期有效解决方案。为了预期未来的实验研究和临床应用，开发了一种用于导线放置的合理方法，并在尸体研究中测试了其可行性。
通过对活体模型和尸体标本进行超声扫描来证实正常解剖结构。设计了一种逐步的超声引导植入技术。该操作针对腋神经和肩胛上神经完成。通过解剖确认导线放置的准确性。
发现植入装置位于距目标神经0.5 - 1厘米范围内。
解剖证实了超声引导下导线放置的准确性。所描述的方法基于正常解剖结构，并且按照所概述的程序步骤似乎是可重复的。
