North R B, Kidd D H, Zahurak M, James C S, Long D M
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Neurosurgery. 1993 Mar;32(3):384-94; discussion 394-5. doi: 10.1227/00006123-199303000-00008.
Over the past two decades, spinal cord stimulation devices and techniques have evolved from single-channel systems, with electrodes requiring laminectomy, into programmable "multichannel" systems with electrodes that may be placed percutaneously. We have reviewed our experience in 320 consecutive patients treated with these devices at our institution between 1972 and 1990. Technical details of treatment as well as patient characteristics have been assessed as predictors of clinical outcome and of hardware reliability by univariate and multivariate statistical methods. Current follow-up has been obtained at intervals from 2 to 20 years (mean, 7.1 yr) postoperatively on 205 patients. All clinical outcome measures have been based on disinterested third-party interview data--standard analog pain ratings, employment status, activities of daily living, and use of analgesics. At 7-year mean follow-up, 52% of the 171 patients who received permanent implants reported at least 50% continued pain relief. A majority had maintained improvements in activities of daily living and analgesic use. Analysis of hardware reliability for 298 permanent implants revealed significantly fewer clinical failures (P < 0.001) and technical failures (in particular, electrode migration and malposition, P = 0.025) as single-channel implants have evolved into programmable, multichannel devices. Our analysis of technical and clinical prognostic factors may be useful to the clinician in selecting patients for this procedure.
在过去二十年中，脊髓刺激装置和技术已从需要椎板切除术的单通道系统，发展为电极可经皮放置的可编程“多通道”系统。我们回顾了1972年至1990年间在我们机构接受这些装置治疗的320例连续患者的经验。通过单变量和多变量统计方法，对治疗的技术细节以及患者特征进行了评估，作为临床结果和硬件可靠性的预测指标。目前对205例患者术后2至20年（平均7.1年）进行了随访。所有临床结果测量均基于客观的第三方访谈数据——标准模拟疼痛评分、就业状况、日常生活活动以及镇痛药的使用情况。在平均7年的随访中，171例接受永久性植入的患者中有52%报告至少有50%的持续疼痛缓解。大多数患者在日常生活活动和镇痛药使用方面保持了改善。对298个永久性植入物的硬件可靠性分析显示，随着单通道植入物发展为可编程多通道装置，临床故障（P < 0.001）和技术故障（特别是电极迁移和位置不当，P = 0.025）显著减少。我们对技术和临床预后因素的分析可能对临床医生选择适合该手术的患者有用。
