脊髄刺激療法における外科的電極留置術の有用性

抄録

  Introduction : Spinal cord stimulation (SCS) is an established treatment method for chronic pain syndrome. Percutaneous placement of cylindrical electrodes is the first choice in most cases, whereas surgical electrode placement is performed when paddle electrodes are used or extensive epidural scar tissue interferes with optimal electrode placement. The objective of this study was to examine the effectiveness of surgical electrode placement in SCS.

  Methods : Patients who had undergone surgical electrode placement from December 2009 to January 2016 were included. The reasons for choosing surgical electrode placement, procedures, pain assessments, and complications were analyzed.

  Result : Surgical electrode placements were performed in 10 (6 male and 4 female) of the 91 patients who underwent electrode placement. Surgical electrode placement was chosen owing to extensive epidural scar tissue in 2 procedures, the use of paddle electrodes in 4 procedures, and for both reasons in 3 procedures. The mean age of the patients was 52 years, with a ranging 38-71 years. Surgical placement was performed twice in a case involving surgical site infection. For the procedures, laminectomies were performed in 6 cases ; partial laminectomies, in 3 cases ; laminoplasty, in 1 case ; lamina exposure only, in 1 case. Nine patients showed at least 50% improvement based on a visual analog scale. The complications included 1 case each of an epidural hematoma and surgical site infection.

  Conclusion : We performed surgical electrode placements in cases in which it was extremely difficult to achieve analgesia with standard SCS and percutaneous placement of cylindrical electrodes, and significant analgesia was achieved in most cases. Laminectomies were useful when extensive epidural scar tissue existed, whereas minimally invasive procedures were effective in cases without extensive epidural scar tissue. It is very important to choose the appropriate procedure for each patient.