脊髓和马尾神经损伤后慢性神经源性疼痛外科治疗策略

目的 探讨脊髓和马尾神经损伤后慢性神经源性疼痛的神经外科治疗策略.方法 脊髓和马尾神经损伤后慢性神经源性疼痛20例,年龄28～81岁,病程8个月～50年.共行镇痛手术23次,其中,脊髓背根入髓区显微外科切开术19次,脊髓电刺激术3次,鞘内靶控输注系统植入术1次.采用视觉模拟评分（VAS）来评估手术疗效,以术后疼痛缓解大于75%为疗效优秀,疼痛缓解50%～75%为良好,疼痛缓解小于50%为差.结果 随访6个月～4年,10例疼痛消失,停用镇痛剂,生活质量改善;7例疼痛明显减轻,VAS 2～4分,其中,5例停用镇痛剂,2例镇痛剂使用量明显下降,生活质量改善;3例疼痛无明显改善.结论 脊髓背根入髓区显微外科切开术和脊髓电刺激术对脊髓和马尾神经损伤后慢性神经源性疼痛患者疗效满意,但其适应证有差别,应根据患者的损伤节段、损伤程度和疼痛部位等具体情况选择手术方式.

Neurosurgical management for chronic neuropathic pain due to spinal cord and cauda equina injuries

Objective To discuss about the neurosurgical management for chronic neuropathic pain due to spinal cord and cauda equina injuries. Methods Twenty cases of neuropathic pain were selected that were due to spinal cord and cauda equina injuries, aged from 28-81 years old and with the duration of illness lasting 8 months to 50 years and totally 23 analgesic surgeries. Among them, 19 cases were microsurgical dorsal root entry zonectomy （MDT）, 3 cases were spinal cord electrical stimulation （SCS） and 1 case was intratheeal target--controlled infusion system implantation. The visual analog score （VAS） was applied to assess the surgical outcome, and the post--operative pain relief extent of larger than 75% was considered excellent. The pain relief extents of 50%-75% and less than 50% were considered good and poor, respectively. Results For the follow-up at 6 months - 4 years post-operatively, pain disappeared in 10 cases and analgesic medication was stopped with improved life quality. Pain was significantly relieved in 7 cases with the VAS of 2-4. Among them, the analgesic medication was stopped in 5 cases and significantly decreased in 2 cases with improved life quality. There was no significant pain relief in 3 cases. Conclusions Satisfactory effects could be achieved by the surgeries of MDT and SCS for chronic neuropathie pain patients due to spinal cord and cauda equine injuries. However, they have different indications and specific surgical approach should be chosen based on the detailed information including the injured segment, extent and pain location of the patients.