Tanei Takafumi, Kajita Yasukazu, Maesawa Satoshi, Nakatsubo Daisuke, Aoki Kosuke, Noda Hiroshi, Takebayashi Shigenori, Nakahara Norimoto, Wakabayashi Toshihiko
Department of Neurosurgery, Nagoya Central Hospital.
Department of Neurosurgery, Nagoya Medical Center.
Neurol Med Chir (Tokyo). 2018 Oct 15;58(10):422-434. doi: 10.2176/nmc.oa.2018-0106. Epub 2018 Aug 30.
The long-term effects of motor cortex stimulation (MCS) and spinal cord stimulation (SCS) remain unknown. To identify the long-term effects after MCS or SCS and determine any associated predictive factors for the outcomes. Fifty patients underwent MCS (n = 15) or SCS (n = 35) for chronic neuropathic pain. The degree of pain was assessed preoperatively, at 1, 6, and 12 months after surgery, and during the time of the last follow-up using Visual Analog Scale (VAS). Percentage of pain relief (PPR) was calculated, with "long-term effect" defined as PPR ≥ 30% and the presence of continued pain relief over 12 months. Outcomes were classified into excellent (PPR ≥ 70%) and good (PPR 30-69%) sub-categories. Long-term effects of MCS and SCS were observed in 53.3% and 57.1% of the patients, respectively. There were no predictive factors of long-term effects identified for any of the various preoperative conditions. However, the VAS at 1 month after surgery was significantly associated with the long-term effects in both MCS and SCS. All patients with an excellent outcome at 1 month after the surgery continued to exhibit these effects. In contrast, patients with the good outcome at 1 month exhibited a significant decrease in the effects at 6 months after surgery. The long-term effects of MCS and SCS were approximately 50% during the more than 8.5 and 3.5 years of follow-up, respectively. The VAS at 1 month after surgery may be a postoperative predictor of the long-term effects for both MCS and SCS.
运动皮层刺激（MCS）和脊髓刺激（SCS）的长期效果尚不清楚。为了确定MCS或SCS后的长期效果，并确定任何与结果相关的预测因素。50例患者因慢性神经性疼痛接受了MCS（n = 15）或SCS（n = 35）治疗。术前、术后1个月、6个月和12个月以及最后一次随访时使用视觉模拟量表（VAS）评估疼痛程度。计算疼痛缓解百分比（PPR），“长期效果”定义为PPR≥30%且持续疼痛缓解超过12个月。结果分为优秀（PPR≥70%）和良好（PPR 30 - 69%）两个亚类。分别在53.3%和57.1%的患者中观察到了MCS和SCS的长期效果。对于任何术前情况，均未发现长期效果的预测因素。然而，术后1个月的VAS与MCS和SCS的长期效果均显著相关。术后1个月预后优秀的所有患者持续表现出这些效果。相比之下，术后1个月预后良好的患者在术后6个月效果显著下降。在超过8.5年和3.5年的随访中，MCS和SCS的长期效果分别约为50%。术后1个月的VAS可能是MCS和SCS长期效果的术后预测指标。
