Texakalidis Pavlos, Tora Muhibullah S, Nagarajan Purva, Keifer Orion P, Boulis Nicholas M
Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
J Pain Res. 2019 Aug 21;12:2547-2553. doi: 10.2147/JPR.S214314. eCollection 2019.
Occipital neuralgia (ON) is defined as paroxysmal pain in the distribution of the greater, lesser, and/or third occipital nerves. ON can be refractory to conservative management and minimally invasive interventions. Neuromodulatory procedures can potentially treat refractory ON and include occipital nerve stimulation and the sparsely reported high cervical spinal cord stimulation (SCS).
To report our experience and conduct a systematic literature review of studies evaluating the effect of high cervical SCS as a treatment modality for refractory ON.
A retrospective review of patients with refractory ON who underwent high cervical SCS was conducted. In addition, a systematic literature review was performed according to the PRISMA guidelines.
Five patients with refractory ON were treated with high cervical (C1-C3) SCS in our institution. Two out of five (40%) patients reported a successful trial stimulation (>50% pain reduction) and received permanent implantation. During the follow-up, the visual analog scale score decreased from 7.5 to 4 and from 6.5 to 5 in these patients. No complications were reported for any of the patients. The systematic literature review, identified two eligible studies, comprising 18 patients overall who underwent cervicomedullary junction SCS. Nine out of 18 patients (50%) had a successful trial and received permanent implantation.
High cervical or cervicomedullary junction SCS is associated with a 40-50% successful trial rate in refractory ON. No major complications were noted during the follow-up. Future studies are needed to compare the different neurosurgical options, in order to identify the optimal treatment strategy for refractory ON.
枕神经痛（ON）被定义为枕大神经、枕小神经和/或第三枕神经分布区域的阵发性疼痛。枕神经痛可能对保守治疗和微创干预无效。神经调节手术有可能治疗难治性枕神经痛，包括枕神经刺激术以及报道较少的高位颈脊髓刺激术（SCS）。
报告我们的经验，并对评估高位颈脊髓刺激术作为难治性枕神经痛治疗方式效果的研究进行系统的文献综述。
对接受高位颈脊髓刺激术的难治性枕神经痛患者进行回顾性研究。此外，根据PRISMA指南进行系统的文献综述。
在我们机构，5例难治性枕神经痛患者接受了高位颈（C1 - C3）脊髓刺激术。5例患者中有2例（40%）报告试验刺激成功（疼痛减轻>50%）并接受了永久植入。在随访期间，这些患者的视觉模拟量表评分分别从7.5降至4以及从6.5降至5。所有患者均未报告并发症。系统的文献综述确定了两项符合条件的研究，总共包括18例接受颈髓交界处脊髓刺激术的患者。18例患者中有9例（50%）试验成功并接受了永久植入。
高位颈或颈髓交界处脊髓刺激术在难治性枕神经痛中的试验成功率为40% - 50%。随访期间未发现重大并发症。未来需要进行研究以比较不同的神经外科手术选择，从而确定难治性枕神经痛的最佳治疗策略。
