Boakye Maxwell, Ball Tyler, Dietz Nicholas, Sharma Mayur, Angeli Claudia, Rejc Enrico, Kirshblum Steven, Forrest Gail, Arnold Forest W, Harkema Susan
Department of Neurosurgery, University of Louisville, Louisville, Kentucky.
Department of Neurosurgery, Vanderbilt University, Nashville.
Surg Neurol Int. 2023 Mar 17;14:87. doi: 10.25259/SNI_1074_2022. eCollection 2023.
Traumatic spinal cord injury (tSCI) is a debilitating condition, leading to chronic morbidity and mortality. In recent peer-reviewed studies, spinal cord epidural stimulation (scES) enabled voluntary movement and return of over-ground walking in a small number of patients with motor complete SCI. Using the most extensive case series ( = 25) for chronic SCI, the present report describes our motor and cardiovascular and functional outcomes, surgical and training complication rates, quality of life (QOL) improvements, and patient satisfaction results after scES.
This prospective study occurred at the University of Louisville from 2009 to 2020. scES interventions began 2-3 weeks after surgical implantation of the scES device. Perioperative complications were recorded as well as long-term complications during training and device related events. QOL outcomes and patient satisfaction were evaluated using the impairment domains model and a global patient satisfaction scale, respectively.
Twenty-five patients (80% male, mean age of 30.9 ± 9.4 years) with chronic motor complete tSCI underwent scES using an epidural paddle electrode and internal pulse generator. The interval from SCI to scES implantation was 5.9 ± 3.4 years. Two participants (8%) developed infections, and three additional patients required washouts (12%). All participants achieved voluntary movement after implantation. A total of 17 research participants (85%) reported that the procedure either met ( = 9) or exceeded ( = 8) their expectations, and 100% would undergo the operation again.
scES in this series was safe and achieved numerous benefits on motor and cardiovascular regulation and improved patient-reported QOL in multiple domains, with a high degree of patient satisfaction. The multiple previously unreported benefits beyond improvements in motor function render scES a promising option for improving QOL after motor complete SCI. Further studies may quantify these other benefits and clarify scES's role in SCI patients.
创伤性脊髓损伤（tSCI）是一种使人衰弱的疾病，会导致慢性发病和死亡。在最近的同行评审研究中，脊髓硬膜外刺激（scES）使少数运动完全性脊髓损伤患者能够实现自主运动并恢复地面行走。本报告使用针对慢性脊髓损伤的最广泛病例系列（n = 25），描述了我们在scES治疗后的运动、心血管和功能结果、手术和训练并发症发生率、生活质量（QOL）改善情况以及患者满意度结果。
这项前瞻性研究于2009年至2020年在路易斯维尔大学进行。scES干预在scES设备手术植入后2 - 3周开始。记录围手术期并发症以及训练期间的长期并发症和与设备相关的事件。分别使用损伤领域模型和全球患者满意度量表评估QOL结果和患者满意度。
25例慢性运动完全性tSCI患者（80%为男性，平均年龄30.9±9.4岁）接受了使用硬膜外片状电极和内部脉冲发生器的scES治疗。从脊髓损伤到scES植入的间隔时间为5.9±3.4年。两名参与者（8%）发生感染，另外三名患者需要冲洗（12%）。所有参与者植入后均实现了自主运动。共有17名研究参与者（85%）报告该手术达到（n = 9）或超出（n = 8）了他们的期望，并且100%愿意再次接受该手术。
本系列中的scES是安全的，在运动和心血管调节方面取得了诸多益处，并在多个领域改善了患者报告的QOL，患者满意度很高。除了运动功能改善之外的多种先前未报告的益处使scES成为改善运动完全性脊髓损伤后QOL的一个有前景的选择。进一步的研究可能会量化这些其他益处，并阐明scES在脊髓损伤患者中的作用。
