Meier Kaare
Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark.
Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.
Scand J Pain. 2014 Jul 1;5(3):175-181. doi: 10.1016/j.sjpain.2014.03.001.
Background Spinal cord stimulation (SCS) is a surgical treatment for chronic neuropathic pain refractory to conventional treatment. SCS treatment consists of one or more leads implanted in the epidural space of the spinal canal, connected to an implantable pulse generator (IPG). Each lead carries a number of contacts capable of delivering a weak electrical current to the spinal cord, evoking a feeling of peripheral paresthesia. With correct indication and if implanted by an experienced implanter, success rates generally are in the range of about 50-75%. Common indications include complex regional pain syndrome (CRPS I), angina pectoris, and radicular pain after failed back surgery syndrome, and the treatment is also used to treat stump pain after amputation, and pain due to peripheral nerve injury, peripheral vascular disease, and diabetic neuropathy. Recommended contraindications for the treatment include pregnancy, coagulopathy, severe addiction to psychoactive substances, and lack of ability to cooperate (e.g. due to active psychosis or cognitive impairment). Most common complications to the treatment include lead migration, lead breakage, infection, pain over the implant, and dural puncture. Despite extensive research in the area, the mechanisms of action are still only partially understood. Methods In this topical review the historical background behind the treatment is described and the current theories on the mechanism of action are presented. The implantation procedure is described in detail and illustrated with a series of intraoperative pictures. Finally, indications for SCS are discussed along with some of the controversies surrounding the therapy. Implications The reader is presented with a broad overview of spinal cord stimulation, including the historical and theoretical background, practical implantation technique, and clinical application.
背景 脊髓刺激（SCS）是一种用于治疗对传统治疗无效的慢性神经性疼痛的外科治疗方法。SCS治疗包括将一根或多根电极导线植入椎管硬膜外间隙，连接到植入式脉冲发生器（IPG）。每根电极导线带有多个能够向脊髓输送弱电流的触点，从而引起外周感觉异常。如果适应证选择正确且由经验丰富的植入者进行植入，成功率通常在约50% - 75%的范围内。常见适应证包括复杂性区域疼痛综合征（CRPS I）、心绞痛以及腰椎手术后失败综合征后的神经根性疼痛，该治疗方法还用于治疗截肢后的残端疼痛以及由周围神经损伤、周围血管疾病和糖尿病性神经病变引起的疼痛。该治疗方法推荐的禁忌证包括妊娠、凝血功能障碍、对精神活性物质严重成瘾以及缺乏合作能力（例如由于活动性精神病或认知障碍）。该治疗最常见的并发症包括电极导线移位、电极导线断裂、感染、植入部位疼痛和硬膜穿刺。尽管在该领域进行了广泛研究，但其作用机制仍仅部分为人所知。方法 在本专题综述中，描述了该治疗方法背后的历史背景，并介绍了当前关于作用机制的理论。详细描述了植入过程并用一系列术中图片进行说明。最后，讨论了SCS的适应证以及围绕该治疗方法的一些争议。意义 本文为读者提供了关于脊髓刺激的广泛概述，包括历史和理论背景、实际植入技术以及临床应用。
