Name: treating low back pain in failed back surgery patients with multicolumn-lead spinal cord stimulation
Uploaded: 2018-06-26T12:30:00
Description: Watch this Scientific Journal Video about Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation at JoVE.com

作者感谢加布里埃尔. 莱顿修改了本文件的最后草稿。

1. 患者选择
<ol><li>对 FBSS20进行诊断。</li>
	<li>
确保 FBSS 病人符合所有纳入标准, 然后接受 SCS 试验:
	<ol>
<li>慢性腰痛和/或根腿疼痛, 最理想的医疗治疗至少6月。</li>
		<li>持续性疼痛, 尽管3种药物治疗 (扑热息痛, 非甾体抗炎药物, 阿片类药物, 抗惊厥药物等)。</li>
		<li>Lemniscal 通路必须保持至少部分完好 (为麻木覆盖痛苦的区域)。</li>
	</ol>
</li>
	<li>排除 FBSS 患?...

<ol>
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Y., Bonhomme, V. L., Renwart, H. J. P., Remacle, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+Multicolumn+Lead+Spinal+Cord+Stimulation+on+Low+Back+Pain+in+Failed+Back+Surgery+Patients:+A+Three-Year+Follow-Up.">Effect of Multicolumn Lead Spinal Cord Stimulation on Low Back Pain in Failed Back Surgery Patients: A Three-Year Follow-Up.</a> Neuromodulation: Technology at the Neural Interface. 20 (7), 668-674 (2017).</li><li>Veizi, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spinal+Cord+Stimulation+(SCS)+with+Anatomically+Guided+(3D)+Neural+Targeting+Shows+Superior+Chronic+Axial+Low+Back+Pain+Relief+Compared+to+Traditional+SCS-LUMINA+Study.">Spinal Cord Stimulation (SCS) with Anatomically Guided (3D) Neural Targeting Shows Superior Chronic Axial Low Back Pain Relief Compared to Traditional SCS-LUMINA Study.</a> Pain Medicine (Malden, Mass). 18 (8), 1534-1548 (2017).</li><li>Chan, C., Peng, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Failed+back+surgery+syndrome.">Failed back surgery syndrome.</a> Pain Medicine. 12 (4), 577-606 (2011).</li><li>Hawker, G., Mian, S., Kendzerska, T., French, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measures+of+adult+pain.">Measures of adult pain.</a> Arthritis Care and Research. 63 (11), 240-252 (2011).</li><li>Deer, T. 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最近的研究表明, SCS 可以可靠地改善 FBSS 患者的不同疼痛成分, 提高他们的生活质量 (如睡眠质量和体力活动), 这些好处是持续的长期随访3,17,18,19。
根据疼痛的定位, 我们使用不同的方法。当患者只有单边 LP, 经皮穿刺8接触铅放置在后脊髓硬膜外空间透视成像和最终位置的?...

失败的背部手术综合征 (FBSS) 指脊柱手术后持续的慢性疼痛。在建立 FBSS 之前, 其他条件, 如持续神经根压迫, 永久性神经根损伤作为原压缩或手术的结果, 蛛网膜炎, 错误的初步诊断, 并记录机械原因腰痛 (如脊柱不稳定, 后关节骨关节炎, spondylolysthesis, 腰痛疼痛), 应排除1,2,3。FBSS 患者可能有严重或残疾的神经病理性疼痛, 该综合征是令人不安的, 因为它是慢性和抗常规治疗。其发病率和患病率与类风湿性关节炎4相似。因此, 它是5工业化社会的一个巨大负担。
脊髓刺激 (scs) 背侧硬膜外引线可用于治疗背部疼痛 (BP) 和腿部疼痛 (LP) 的 FBSS 患者, 虽然 SCS 疼痛缓解机制尚未充分调查。根据 Melzack 和帕特里克墙在1965年首次提出的门控理论, 大脑监视着一个微小神经网络的活动, 它沿脊髓的背角分布, 受伤害调节, 而且非伤害传入6。当强烈的触觉刺激被应用到同一个地方7,8时, 这些复杂电路在脊髓的浅背角负责减轻在身体的一个特定位置的痛苦。然而, 一些研究表明, SCS 不仅依赖于这个理论。据报道, 几种神经递质 (乙酰胆碱、伽玛丁酸和血清素) 在 SCS 机制9、10、11、12以及许多脑区都有作用。13,14和不同的脊髓纤维15。
SCS 设备包括硬膜外引线、内部脉冲发生器 (IPG) 和用于将引线连接到 IPG 的扩展电缆。刺激设置由外部遥控器调整。可使用两种电极, 即经皮穿刺和手术导通。
在过去发表的研究 (包括证据研究16) 中, SCS 在改善 FBSS 根 LP 成分方面的功效已经得到证实, 最近两项新技术已证明对 BP 的治疗是有效的。成分, 这是众所周知的是顽固的 SCS。第一个是高频刺激17。第二个是手术用的3,18。前者的主要缺点是, 他们的电池需要更频繁的充电和编程优化是挑战的更长的 "洗涤" 时间19。后者的技术比经皮高频刺激技术更具侵入性, 因为它需要一个小的椎板切除术, 使得围手术麻木在局部麻醉下具有挑战性, 尽管可能3。事实上, 这个程序可以在局部麻醉下进行, 辅以有意识镇静或脊椎麻醉3。在我们的机构, 当针对 FBSS 患者的背部疼痛, 我们把这样的手术线索通过一个小椎板切除在10胸水平与病人全麻。3年随访18, 证明了该方法与多列导线治疗 FBSS 患者的 LP 和 BP 的持久疗效。下面给出了我们的方法的详细协议。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>16-20 GA needle</td>
			<td>BD Insyte- W</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>NaCl 0.9% 1 L</td>
			<td>Baxter</td>
			<td>AKE1324</td>
			<td></td>
		</tr>
		<tr>
			<td>Iso-betadine Dermic (500mL)</td>
			<td>MEDA</td>
			<td>09461.16</td>
			<td></td>
		</tr>
		<tr>
			<td>Iso-betadine Soap (500mL)</td>
			<td>MEDA</td>
			<td>09462.10</td>
			<td></td>
		</tr>
		<tr>
			<td>Iso-betadine hydroalcoolic (125 mL)</td>
			<td>MEDA</td>
			<td>41534.1</td>
			<td></td>
		</tr>
		<tr>
			<td>Ziehm Vision R FD</td>
			<td>Ziehm Imaging Inc.</td>
			<td>CB05183</td>
			<td></td>
		</tr>
		<tr>
			<td>Marcain 0.5% + adrenaline 1/200.000 20 mL</td>
			<td>Astrazenca</td>
			<td>PA 970/46/2</td>
			<td>0.5% Bupivacaine/1:200,000 adrenaline solution&#160;</td>
		</tr>
		<tr>
			<td>external Neurostimulator (eNs)&#160;</td>
			<td>&#160;Medtronic Inc., MN, USA</td>
			<td>37022</td>
			<td></td>
		</tr>
		<tr>
			<td>Trousse de colonne lombaire CHR Citadelle (Procedure pack)&#160;</td>
			<td>M&#246;lnlycke</td>
			<td>97061425-01</td>
			<td></td>
		</tr>
		<tr>
			<td>OR Table</td>
			<td>Maquet</td>
			<td>1150.30D0</td>
			<td></td>
		</tr>
		<tr>
			<td>OR Lights</td>
			<td>Trumpf</td>
			<td>1929278</td>
			<td></td>
		</tr>
		<tr>
			<td>Specify SureScan MRI</td>
			<td>&#160;Medtronic Inc., MN, USA</td>
			<td>977C165</td>
			<td>Multicolumn lead</td>
		</tr>
		<tr>
			<td>Primeadvanced surescan mri neurostimulator&#160;</td>
			<td>&#160;Medtronic Inc., MN, USA</td>
			<td>97702</td>
			<td>Internal Pulse Generator</td>
		</tr>
		<tr>
			<td>Monocryl 3/0</td>
			<td>Ethicon</td>
			<td>Y423</td>
			<td></td>
		</tr>
		<tr>
			<td>Polysorb 2/0</td>
			<td>Covidien</td>
			<td>GL123</td>
			<td></td>
		</tr>
		<tr>
			<td>Polysorb 1</td>
			<td>Covidien</td>
			<td>CL535</td>
			<td></td>
		</tr>
		<tr>
			<td>Polysorb 2</td>
			<td>Covidien</td>
			<td>CL055</td>
			<td></td>
		</tr>
		<tr>
			<td>Cutiplast Steril 20x10 cm</td>
			<td>Smith&#38;Nephew</td>
			<td>66001475</td>
			<td>Bandage</td>
		</tr>
		<tr>
			<td>MyStim Programmer</td>
			<td>&#160;Medtronic Inc., MN, USA</td>
			<td>97740</td>
			<td></td>
		</tr>
		<tr>
			<td>FixoCath</td>
			<td>Pajunk</td>
			<td>001151-37Z</td>
			<td></td>
		</tr>
		<tr>
			<td>N&#39;Vision Programmer&#160;</td>
			<td>&#160;Medtronic Inc., MN, USA</td>
			<td>8840</td>
			<td></td>
		</tr>
		<tr>
			<td>3M Tegaderm Film 10x12cm</td>
			<td>3M Deutschland GmbH</td>
			<td>1626W</td>
			<td></td>
		</tr>
		<tr>
			<td>Extension Kit</td>
			<td>Medtronic Inc., MN, USA</td>
			<td>37081-40</td>
			<td></td>
		</tr>
		<tr>
			<td>Paracetamol</td>
			<td>Fresenius Kabi</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Tradonal&#160;</td>
			<td>Meda Pharma</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Sufentanil</td>
			<td>Janssen- Cilag</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Propolipid 1%</td>
			<td>Fresenius Kabi</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Ketalar (Ketamine Hydrochloride)</td>
			<td>Pfizer</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Rocuronium Bromide</td>
			<td>Bbraun</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Cefazolin</td>
			<td>Milan</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

treating low back pain in failed back surgery patients with multicolumn-lead spinal cord stimulation

失败的背部手术综合征 (FBSS) 指脊柱手术后持续的慢性疼痛。脊髓刺激的背侧硬膜外引线可用于治疗背部和腿部疼痛的 FBSS 患者。本文提出了在 FBSS 患者中应用脊髓刺激术治疗线索的详细方案。在我们的部门, 病人在全身麻醉下, 我们在硬膜外的空间, 通过一个小椎板切除在10胸部水平的铅。铅的放置后, 一个1月的试用期与外部的铅。如果在这1月的刺激试验结束时止痛大于 50% (比利时报销标准要求), 则将内部脉冲发生器置于皮肤下, 并在第二个手术过程中与铅连接。我们已经证明, 使用这种技术在严格选择的 FBSS 患者可以显著改善背部疼痛, 腿部疼痛, 病人的活动, 和生活质量持续一段时间。

在我中心, 比利时列日的 Citadelle, 最近在调节18发表了一项前瞻性的, 非随机的, 对照研究62例被植入多列铅的连续 FBSS 患者。所有患者都曾进行过脊柱手术, 已筛查可能导致其疼痛的次要原因, 并对最佳的医疗治疗是不难的。在全身麻醉的透视控制下, 62 例患者在中线位置 T8-T9 的投射中放置了几列手术线索。在试验期结束时, 五十四例患者 (87%) 有 > 50% 的疼?...

Watch this Scientific Journal Video about Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation at JoVE.com

Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation

多列铅脊髓刺激术后腰痛的治疗

本文提出了一种利用脊髓刺激治疗失败后手术患者神经病理性腰痛的方法。

Failed back surgery syndrome (FBSS) refers to persistent, chronic pain following spinal surgery. Spinal cord stimulation with dorsal epidural leads can be ...

Research

JoVE Journal

Behavior

Functional Magnetic Resonance Imaging (fMRI) with Auditory Stimulation in Songbirds

Functional Magnetic Resonance Imaging fMRI with Auditory Stimulation in Songbirds

功能磁共振成像（fMRI）技术与听觉刺激鸣禽

The neurobiology of birdsong, as a model for human speech, is a pronounced area of research in behavioral neuroscience. Whereas electrophysiology and ...

科研

行为学

Use of the Operant Orofacial Pain Assessment Device (OPAD) to Measure Changes in Nociceptive Behavior

Use of the Operant Orofacial Pain Assessment Device OPAD to Measure Changes in Nociceptive Behavior

使用操作性口面疼痛评估设备（OPAD）测量伤害行为的变化

We present an operant  system for the detection of pain in awake, conscious rodents. The Orofacial  Pain Assessment Device (OPAD) assesses pain behaviors ...

Stimulating the Lip Motor Cortex with Transcranial Magnetic Stimulation

刺激唇部运动皮层与经颅磁刺激

Transcranial magnetic stimulation (TMS) has proven to be a useful tool in investigating the role of the articulatory motor cortex in speech perception. ...

Treating Clinical Depression with Repetitive Deep Transcranial Magnetic Stimulation Using the Brainsway H1-coil

临床治疗抑郁症的深层重复经颅磁刺激使用Brainsway H1线圈

Repetitive transcranial magnetic stimulation (rTMS) is an emerging non-pharmacological approach to treating many brain-based disorders. rTMS uses ...

Eye-Tracking Control to Assess Cognitive Functions in Patients with Amyotrophic Lateral Sclerosis

眼跟踪控制，以评估患者的认知功能与肌萎缩性脊髓侧索硬化症

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with pathological involvement of upper and lower motoneurons, subsequently leading to ...

Using Laser Doppler Imaging and Monitoring to Analyze Spinal Cord Microcirculation in Rat

激光多普勒成像与监测在大鼠脊髓微循环分析中的应用

Laser Doppler flowmetry (LDF) is a noninvasive method for blood flow (BF) measurement, which makes it preferable for measuring microcirculatory ...

Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury

脊髓损伤后下肢电刺激训练的模式

Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with ...

Brain State-dependent Brain Stimulation with Real-time Electroencephalography-Triggered Transcranial Magnetic Stimulation

脑状态依赖性脑刺激与实时脑脑图触发颅内磁刺激

The effect of a stimulus to the brain depends not only on the parameters of the stimulus but also on the dynamics of brain activity at the time of the ...

Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease

稳定慢性阻塞性肺病患者家庭处方肺运动

As a systemic disease, chronic obstructive pulmonary disease (COPD) affects the respiratory system, inducing restless and exercise dyspnea. It also ...

Using Unidirectional Rotations to Improve Vestibular System Asymmetry in Patients with Vestibular Dysfunction

使用单向旋转改善前庭功能障碍患者的前庭系统不对称性

The vestibular system provides information about head movement and mediates reflexes that contribute to balance control and gaze stabilization during ...