He Qiheng, Han Bin, Xia Xiaoyu, Dang Yuanyuan, Chen Xueling, He Jianghong, Yang Yi
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China.
Front Neurol. 2022 Jul 4;13:947464. doi: 10.3389/fneur.2022.947464. eCollection 2022.
Spinal cord stimulation (SCS) has been reported to be a promising neuromodulation method for patients with disorders of consciousness (DOC). Our previous studies found that clinical characteristics of patients and SCS stimulation parameters could affect the therapeutic effects of SCS, while surgical-related factors remain unknown. Through the improvement of surgical procedures, most of the SCS electrodes are implanted in the middle, while a small number of electrodes have still deviated.
A total of 137 patients received SCS treatment in our institutions from 1 January 2010 to 31 December 2020. Among them, 27 patients were found with electrode deviation and met the inclusion criteria. Patients were grouped according to whether the electrode deviation angle (EDA) is >30°, respectively. Clinical characteristics of patients and SCS stimulation parameters were compared. Potential related factors and outcomes were evaluated by Chi-square test or two-way repeated measures analysis.
Twenty seven patients receiving cervical SCS treatment were found to have electrode deviation postoperatively. Among them, 12 patients were classified into the more deviation group. No significant difference was found among age, sex, pathogeny, course of DOC, C2-C5 distance, spinal cord to spinal canal ratio at C2 level, and preoperative JFK Coma Recovery Scale-Revised (CRS-R) scores. We found that the electrode direction significantly deviated to the contralateral side in the lateral decubitus position ( = 0.025). The maximum tolerant stimulation intensity in the less deviation group (1.70 ± 0.41) was significantly higher than that in the more deviation group (1.25 ± 0.34) ( = 0.006). Under the strongest stimulation, less unilateral limb tremor ( = 0.049) and paroxysmal sympathetic hyperactivity (PSH) episodes ( = 0.030) were found. EDA had a significant effect on postoperative CRS-R in patients, and patients in the less deviation group had significantly higher postoperative CRS-R ( < 0.01). There was also an interaction effect between EDA and postoperative time. With the prolonged postoperative time, the CRS-R improvement rate of patients with different EDA was different, and the CRS-R improved faster in patients with less EDA ( < 0.05).
Electrode deviation will affect the outcome of patients receiving cervical SCS treatment. The intraoperative surgical position is associated with postoperative electrode deviation direction. The reduction of EDA under 30° can increase maximum tolerant stimulation intensity, reduce complications, and further improve patients' outcomes.
脊髓刺激（SCS）已被报道为一种治疗意识障碍（DOC）患者的有前景的神经调节方法。我们之前的研究发现患者的临床特征和SCS刺激参数会影响SCS的治疗效果，而手术相关因素尚不清楚。通过改进手术操作，大多数SCS电极被植入在中间位置，但仍有少数电极发生了偏移。
2010年1月1日至2020年12月31日期间，共有137例患者在我们机构接受了SCS治疗。其中，27例患者被发现电极偏移且符合纳入标准。根据电极偏移角度（EDA）是否>30°对患者进行分组，比较患者的临床特征和SCS刺激参数。通过卡方检验或双向重复测量分析评估潜在相关因素和结果。
27例接受颈段SCS治疗的患者术后被发现有电极偏移。其中，12例患者被归类为偏移较大组。在年龄、性别、病因、DOC病程、C2 - C5距离、C2水平脊髓与椎管比值以及术前修订的JFK昏迷恢复量表（CRS - R）评分方面未发现显著差异。我们发现，在侧卧位时电极方向显著向对侧偏移（P = 0.025）。偏移较小组的最大耐受刺激强度（1.70±0.41）显著高于偏移较大组（1.25±0.34）（P = 0.006）。在最强刺激下，发现单侧肢体震颤较少（P = 0.049）且阵发性交感神经过度兴奋（PSH）发作较少（P = 0.030）。EDA对患者术后CRS - R有显著影响，偏移较小组患者术后CRS - R显著更高（P < 0.01）。EDA与术后时间之间也存在交互作用。随着术后时间延长，不同EDA患者的CRS - R改善率不同，EDA较小的患者CRS - R改善更快（P < 0.05）。
电极偏移会影响接受颈段SCS治疗患者的预后。术中手术体位与术后电极偏移方向有关。将EDA降低至30°以下可增加最大耐受刺激强度，减少并发症，并进一步改善患者预后。
