Ohnmeiss D D, Rashbaum R F, Bogdanffy G M
Institute for Spine and Biomedical Research, Plano, Texas, USA.
Spine (Phila Pa 1976). 1996 Jun 1;21(11):1344-50; discussion 1351. doi: 10.1097/00007632-199606010-00013.
The results of spinal cord stimulation were prospectively evaluated using both subjective patient self-report measures and objective physical functional testing.
The purpose of this study was to evaluate prospectively the effects of spinal cord stimulation implantation, performed with the patient awake and providing feedback, in patients with primary reports of intractable leg pain.
Spinal cord stimulation has been used for treating chronic pain of many types. However, even among those with intractable lower extremity pain, the outcome results have shown great variability.
The surgical procedure was performed with the patient awake and providing feedback to ensure optimal pain relief from the lead placement. The study group comprised 40 patients, ranging in age from 28 to 86 years. The average symptom duration was 65.4 months, and the average number of prior lumbar spine surgeries was 2.3 (range, 1 to 8). The primary data collection periods were preoperative, 6 weeks after, and 12 and 24 months after surgery.
Statistically significant improvement in isometric lower extremity function was demonstrated 6 weeks after the spinal cord stimulation implantation. In the more painful leg, the performance increased from 457.5 ft-lb-sec to 629.8 ft-lb-sec (P < 0.01). The performance remained significantly improved at the 12- and 24-month follow-ups. Significant improvement was demonstrated on the physical scale of the Sickness Impact Profile at 6 weeks. At 24 months, all three scales (physical, psychological, and other) as well as the total score were significantly improved. Statistically significant decreases in pain, assessed by changes in visual analog scale scores, were noted in the legs, when walking, and in overall lifestyle. The use of narcotic medication decreased at all follow-up periods. At least 66% of the patients who were taking narcotics before spinal cord stimulation were taking reduced amounts or no narcotics 2 years later. At the time of the 24-month follow-up, at least 70% of patients reported that the procedure helped them, and would recommend it to someone with similar symptoms.
Spinal cord stimulation implantation can result in improved physical function and decreased pain in patients who are carefully screened and in whom the implantation is performed with the patient awake to help ensure optimal pain-relieving lead placement.
采用患者主观自我报告测量和客观身体功能测试对脊髓刺激的结果进行前瞻性评估。
本研究的目的是前瞻性评估在清醒且能提供反馈的患者中进行脊髓刺激植入术对主要报告为顽固性腿痛患者的效果。
脊髓刺激已被用于治疗多种类型的慢性疼痛。然而，即使在那些患有顽固性下肢疼痛的患者中，结果也显示出很大的变异性。
手术在患者清醒并提供反馈的情况下进行，以确保从电极放置中获得最佳疼痛缓解。研究组包括40名患者，年龄在28至86岁之间。平均症状持续时间为65.4个月，既往腰椎手术的平均次数为2.3次（范围为1至8次）。主要数据收集期为术前、术后6周、12个月和24个月。
脊髓刺激植入术后6周，等长下肢功能有统计学意义的改善。在疼痛更严重的腿部，表现从457.5英尺 - 磅 - 秒增加到629.8英尺 - 磅 - 秒（P < 0.01）。在12个月和24个月的随访中，表现仍显著改善。术后6周，疾病影响量表的身体维度有显著改善。在24个月时，所有三个维度（身体、心理和其他）以及总分均有显著改善。通过视觉模拟量表评分变化评估，在行走时腿部以及总体生活方式方面的疼痛有统计学意义的降低。在所有随访期，麻醉药物的使用都减少了。在脊髓刺激术前服用麻醉药物的患者中，至少66%在2年后服用量减少或不再服用。在24个月随访时，至少70%的患者报告该手术对他们有帮助，并会向有类似症状的人推荐。
对于经过仔细筛选且在患者清醒状态下进行植入以确保最佳止痛电极放置的患者，脊髓刺激植入术可改善身体功能并减轻疼痛。
