neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2018-20-2-43-49neurosurgery-550Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTПостоянная эпидуральная стимуляция спинного мозга в лечении фармакорезистентной боли у пациентов с синдромом неудачной операции на позвоночникеApplication of spinal cord stimulation in the treatment of persistent pain in failed back surgery syndromehttps://orcid.org/0000-0003-3578-6915ДмитриевА. Б.DmitrievA. В.

Александр Борисович Дмитриев

630087 Новосибирск, ул. Немировича-Данченко, 132/1

a_dmitriev@neuronsk.ruhttps://orcid.org/0000-0002-1209-8960РзаевД. А.RzaevD. A.

630087 Новосибирск, ул. Немировича-Данченко, 132/1

https://orcid.org/0000-0002-6076-5262ДенисоваН. П.DenisovaN. P.

630087 Новосибирск, ул. Немировича-Данченко, 132/1

ФГБУ «Федеральный центр нейрохирургии» Минздрава России (Новосибирск)РоссияFederal Neurosurgical Center (Novosibirsk), Ministry of Health of RussiaRussian Federation2018190720182024349Copyright © Дмитриев А.Б., Рзаев Д.А., Денисова Н.П., 20182018Дмитриев А.Б., Рзаев Д.А., Денисова Н.П.Dmitriev A.В., Rzaev D.A., Denisova N.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/550

Цель исследования – демонстрация собственного опыта применения постоянной стимуляции спинного мозга в терапии фармакорезистентной боли у пациентов с синдромом неудачной операции на позвоночнике, а также оценка эффективности данного метода и частоты осложнений.

Материалы и методы

Материалы и методы. За 2013–2015 гг. в Федеральном центре нейрохирургии (Новосибирск) 78 пациентам, страдающим синдромом неудачной операции на позвоночнике, имплантирована система для постоянной спинальной стимуляции. Все пациенты перенесли нейрохирургическое вмешательство на позвоночнике и имели фармакорезистентный болевой синдром нейрогенного характера. Оценка эффективности лечения проводилась с использованием визуально-аналоговой шкалы (ВАШ) и опросника Douleur Neuropathique en 4 Questions (DN4). Катамнез составил от 6 до 18 мес.

 Результаты

 Результаты. Средняя оценка по ВАШ до операции составила 6,7 балла, при выписке – 3,1 балла, через 6 мес – 3,2 балла, через 12 мес – 3,5 балла, через 18 мес – 3,4 балла. По шкале DN4 средний показатель до операции равнялся 5,3 балла, при выписке – 2,1 балла, через 6 мес – 2,4 балла, через 12 мес – 2,5 балла, через 18 мес – 2,4 балла. Осложнения (миграция, перелом электродов и кровоизлияние или воспаление в месте имплантации системы), которые потребовали ревизионных операций, развились в 12 (15,3 %) случаях.

Заключение

Заключение. Спинальная стимуляция эффективно и безопасно снижает выраженность боли при синдроме неудачной операции на позвоночнике, однако имеет специфические осложнения, связанные с имплантируемыми системами.

The study objective is to demonstrate our experience of the spinal cord stimulation in the treatment of drug-resistant pain in patients with the failed back surgery syndrome (FBSS) and to evaluate its effectiveness and complications.

Materials and methods

Materials and methods. Systems for chronic spinal cord stimulation were implanted in 78 patients suffering from FBSS in Federal Neurosurgical Center (Novosibirsk) during 2013–2015. All patients had a drug-resistant neurogenic pain syndrome character and were undergone surgical intervention on the spine. Evaluating of the treatment effectiveness was carried out by visual analogue scale (VAS) and a scale Douleur Neuropathique en 4 Questions (DN4). Catamnesis ranged from 6 to 18 months.

Results

Results. The median preoperative VAS score evaluation was 6.7, at hospital discharge – 3.1, after 6 months – 3.2, after 12 months – 3.5, after 18 months – 3.4. Evaluation on a scale DN4 before surgery was 5.3, at hospital discharge – 2.1, after 6 months – 2.4, after 12 months – 2.5, after 18 months – 2.4. Complications in the form of migration, fracture of the electrodes and development of hemorrhage or inflammation at the site of implantation of the system were observed in 12 (15.3 %) cases and required revision surgery.

Conclusion

Conclusion. Spinal stimulation is an effective and safe method of treatment of pain in FBSS, but it has specific complications associated with implantable systems.

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The authors declare that there are no conflicts of interest present.