Hu Zhouyang, Wang Hong, Xu Zhipeng, Zhang Jianjin, Li Lijun, Fan Guoxin, Liao Xiang
Department of Pain Medicine, Shenzhen Nanshan People's Hospital, Shenzhen University Medical School, Shenzhen, China.
Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen, China.
J Cent Nerv Syst Dis. 2024 Nov 29;16:11795735241302715. doi: 10.1177/11795735241302715. eCollection 2024.
The paddle lead (PL) and cylindrical lead (CL) remain the main implant categories in spinal cord stimulation (SCS) for treating neuropathic pain. Surgeons often complain about the greater trauma associated with PL implantation, while percutaneous endoscopic technique offers a promising approach for minimizing the trauma associated to PL implantation. However, there remains a dearth of real-world case study on endoscopy-assisted CL implantation.
This study aimed to demonstrate the endoscopic-assisted approach and outcomes of CL implantation in SCS for managing neuropathic pain.
A retrospective case series.
Patients aged 18 years and above with chronic neuropathic pain persisting for at least three months, refractory to standardized conservative treatment, were enrolled between January 2021 and March 2023.
The surgical key steps including puncture, working cannula placement, endoscopic laminotomy and endoscopic CL introduction were demonstrated. Characteristics as demographics, follow-up time, visual analog scale (VAS) score, pain disability index (PDI) score and patient-reported outcomes measurement information system (PROMIS) scale were assessed.
Successful CL implantation under endoscopy was achieved in all patients, including 3 with failed back surgery syndrome, 2 with complex regional pain syndrome and 2 with chronic pelvic pain. No spinal cord injuries, dural tears, lead migration, lead fractures, or postoperative infections were observed. VAS score of regional pain, PDI score as well as PROMIS of patient's quality of life were all significantly improved after surgery.
Percutaneous endoscope-assisted CL implantation offered a new alternative technique for SCS in managing neuropathic pain.
在脊髓刺激（SCS）治疗神经性疼痛中，板状电极（PL）和柱状电极（CL）仍是主要的植入类型。外科医生经常抱怨PL植入相关的创伤更大，而经皮内镜技术为最小化与PL植入相关的创伤提供了一种有前景的方法。然而，关于内镜辅助CL植入的真实世界案例研究仍然匮乏。
本研究旨在展示SCS中内镜辅助CL植入治疗神经性疼痛的方法及结果。
一项回顾性病例系列研究。
纳入2021年1月至2023年3月期间年龄在18岁及以上、慢性神经性疼痛持续至少三个月且对标准化保守治疗无效的患者。
展示了包括穿刺、工作套管置入、内镜下椎板切开术和内镜下CL置入等手术关键步骤。评估了患者的人口统计学特征、随访时间、视觉模拟量表（VAS）评分疼痛残疾指数（PDI）评分以及患者报告结局测量信息系统（PROMIS）量表。
所有患者均成功在内镜下完成CL植入，其中包括3例腰椎手术失败综合征患者、2例复杂性区域疼痛综合征患者和2例慢性盆腔疼痛患者。未观察到脊髓损伤、硬脊膜撕裂、电极移位、电极断裂或术后感染。术后区域疼痛的VAS评分、PDI评分以及患者生活质量的PROMIS评分均显著改善。
经皮内镜辅助CL植入为SCS治疗神经性疼痛提供了一种新的替代技术。
