【晨读】脊髓电刺激（六）
英语晨读 ·
山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。
本次文献选自ROCK AK , Truong H , Park YL, et al. Spinal Cord Stimulation[J]. Neurosurg Clin N Am, 2019, 30(2):169-194.本次学习由谢珺田副主任医师主讲。
Once a patient undergoes a successful SCS trial, several decisions must be made: (1) should patients undergo percutaneous or paddle implantation, (2) are there any technical nuances that must be considered, (3) should the procedure be performed asleep or awake, and (4) what waveform should be used? The patients’ trial data, their overall health, surgeon comfort, and local expertise or resources are factors that play a role in making these decisions. However, there is often not a single “right or wrong” decision to be made.
技术方面
如果患者行SCS测试治疗有效，接下来就必须考虑以下几个问题：（1）患者是否应进行经皮或外科手术永久电极植入；（2）二者技术上的不同之处；（3）是适合在睡眠状态下手术，还是在清醒状态下进行手术；（4）应采用何种波形编程方案？患者的试验治疗参数、整体健康状况、手术医生的偏好以及所掌握的的专业知识或资源是支撑做出这些决定的因素。然而，这些决定往往不是简单的“对或错”的决策问题。
Lead Type
Experiences with percutaneous and paddle implants are well documented in the literature. Although both are excellent options, the choice of one type of lead over another depends on the expertise, work flow, and practical issues. Percutaneous leads involve a less invasive procedure and are less likely to result in postoperative complications (2.2% compared with 3.4% in patients with paddle leads). For patients with multiple comorbidities, percutaneous leads may be a better choice. Although paddle leads require a more invasive surgery through hemi-laminotomy, satisfaction and pain relief may be higher. Similar rates of lead migration have been described for each type of lead, but migration tends to be less extreme for paddle implants. 55 Lastly, the contacts of paddle implants all face the epidural space, which allows for more effective energy delivery. A recent study suggested that minimally invasive surgery techniques is feasible for placement of SCS with possible advantage.
电极种类
经皮电极和手术植入电极的相关经验在文献中已有详尽的陈述。尽管这两种方法都是不错的治疗选择，但选择哪一种方法应取决于专业知识的熟悉程度、工作流程是否畅通和诸多的其它实际问题。经皮穿刺电极操作创伤轻微，术后并发症发生率低（2.2%，而手术电极植入患者为3.4%）。对于有多种合并疾病的患者，经皮电极植入可能是一个更好的选择。虽然手术电极需要通过半椎板切开术进行创伤较大的手术，但满意度和疼痛缓解可能更好。对于各种类型的电极，移位发生率均相似，但对于手术植入电极，移位发生率则大大减低。最后，手术植入电极的接触面都朝向硬膜外腔，这样可以更有效地扩布电场。最近的一项研究表明，通过微创技术安置手术电极是可行的，且具有独到的优势。