Ragel Brian T, McGehee Matthew, Karvelas Nicolas, Raslan Ahmed M
Division of Neurosurgery, Rebound Orthopedics and Neurosurgery, Vancouver, Washington, USA.
Department of Physiatry, NorthShore University Health System, Chicago, Illinois, USA.
Pain Pract. 2024 Sep 6. doi: 10.1111/papr.13414.
It is not uncommon for patients to experience postoperative neurologic deficit, thoracic radiculopathy, abdominal pain, or lower extremity paresthesia after the implantation of thoracic spinal cord stimulator (SCS) paddle leads. Smaller thoracic canal diameters have previously been associated with postoperative neurologic deficits.
This imaging study examined whether postoperative SCS neurologic complaints other than neurologic deficit may be correlated with thoracic spinal canal diameter.
Patients who underwent thoracic laminotomy for SCS paddle lead placement between January 2018 and March 2023 were identified. Preoperative thoracic canal diameter was measured on MRI or CT imaging in the sagittal plane from T5/6 to T11/12. The canal diameters of patients with and without new postoperative neurologic complaints were compared.
Two hundred forty-six patients underwent thoracic laminotomy for SCS paddle lead placement. Thoracic radiculopathy, abdominal pain, and lower extremity paresthesia occurred in 3.7% (9/246), 2.8% (7/246), and 2.0% (5/246) patients, respectively. The mean canal diameter for patients without neurologic complaint, thoracic radiculopathy, abdominal pain, and lower extremity paresthesia was 13.1 mm, 12.0 mm (p < 0.0001), 12.1 mm (p < 0.01), and 12.8 mm (p = 0.365), respectively.
A smaller thoracic canal diameter is associated with postoperative thoracic radiculopathy and abdominal pain. We believe that surgical planning to create adequate space for SCS leads is critical in preventing postoperative neurologic complaints of deficit, thoracic radiculopathy, and abdominal pain.
在植入胸段脊髓刺激器（SCS）片状电极后，患者出现术后神经功能缺损、胸神经根病、腹痛或下肢感觉异常的情况并不少见。此前，较小的胸段椎管直径与术后神经功能缺损有关。
本影像学研究旨在探讨除神经功能缺损外，术后SCS神经方面的主诉是否与胸段椎管直径相关。
确定2018年1月至2023年3月期间因植入SCS片状电极而接受胸段椎板切开术的患者。术前在矢状面的MRI或CT图像上测量T5/6至T11/12节段的胸段椎管直径。比较有无新的术后神经方面主诉的患者的椎管直径。
246例患者因植入SCS片状电极而接受胸段椎板切开术。胸神经根病、腹痛和下肢感觉异常分别发生在3.7%（9/246）、2.8%（7/246）和2.0%（5/246）的患者中。无神经方面主诉、胸神经根病、腹痛和下肢感觉异常的患者的平均椎管直径分别为13.1mm、12.0mm（p<0.0001）、12.1mm（p<0.01）和12.8mm（p=0.365）。
较小的胸段椎管直径与术后胸神经根病和腹痛相关。我们认为，为SCS电极创造足够空间的手术规划对于预防术后神经功能缺损、胸神经根病和腹痛的神经方面主诉至关重要。
