While some people with chronic pain enjoy enormous benefit from spinal cord stimulation, 这些设备并不适合所有人. 神经外科医生William S. 安德森, who specializes in functional neurosurgery including neuromodulation techniques, 讨论了为什么有些推荐十大正规网赌平台会选择逆转手术.

什么是脊髓刺激器移除?

脊髓刺激器移除术是一种外科手术 脊髓刺激器, a device that was originally implanted above the spinal cord to manage chronic pain.

为什么要移除脊髓刺激器?

“The most common reason for 脊髓刺激器 removal is inadequate pain relief,安德森说。. 根据经验, surgeons aim for at least a 50% reduction in pain when initially implanting a 脊髓刺激器, 但没有客观的方法来衡量疼痛程度. “We typically let patients decide whether they keep their device or not; most live with the stimulator for two to three years before considering removal.”

脊髓刺激器会出什么问题，你怎么知道?

脊髓刺激器, 虽然是一个安全且经过测试的设备, 植入几年后可能会出现问题. 发生这种情况的原因有很多, 包括机械故障, 感染和一般缺乏疗效.

除了不能充分缓解疼痛, a 脊髓刺激器 could lead to problems that may require additional procedures to maintain or reposition the device. 这些问题可能包括:

铅迁移

如果导线(植入物)移动, the tingling sensation caused by your stimulator (often called paresthesias) will shift to a different part of the body. This often reduces your device’s ability to control your pain, so it will feel more severe.

设备损坏

If the lead or pulse generator (battery pack) breaks — after a fall or other trauma or just normal wear and tear — the paresthesias will cease completely, 你的刺激器也无法缓解你的疼痛.

In rare cases, the device can malfunction, causing pain or a sudden jolting sensation.

感染

脊髓刺激器周围的感染会引起肿胀, 发红, pain or discharge in that specific area or more general symptoms like fever or delirium. 感染在电池组附近比在引线处更常见.

如果你的设备有任何问题，请告诉你的医生. 现代脊髓刺激器可以无线发送诊断信息, allowing your surgeon to identify mechanical and electrical issues remotely.

如何取出脊髓刺激器?

Spinal cord stimulator removal surgery varies depending on the type of lead your device uses. 脊髓刺激器由两部分组成:电池, 为设备供电, 还有引线, 它们传递刺激.

有两种导联:经皮导联和桨状导联. Percutaneous leads are inserted into the spine with an epidural needle and are smaller and easier to remove. 桨领导, 相比之下, are larger and usually anchored to the spinal column under a small piece of bone during a 椎板切除术手术. 它们仍然是可拆卸的，但手术过程更复杂.

“Removing these leads, especially the larger ones, is not a trivial procedure. It’s best done by a surgeon with significant experience in this area,” advises 安德森. You may expect to spend a night in the hospital after a paddle lead removal.

脊髓刺激器移除:经皮导联

取出经皮导联的脊髓刺激器, 外科医生会沿着背部做一个小的垂直切口, 暴露一部分脊柱，即导线所在的位置. 经皮导联通常用塑料锚固定, which your surgeon will locate to carefully extract the device from the epidural space, 脊椎骨和脊髓之间的脆弱区域.

一旦引线出来, your surgeon will make another incision to remove the implantable pulse generator, 哪个部位通常位于下背部或臀部.

当两个组件已经断开并移除, 外科医生缝合切口, 整个过程就完成了.

The surgery takes about an hour and is typically performed while you are under general anesthesia. Depending on your health, your surgeon may recommend lighter local anesthesia instead.

脊髓刺激器移除:桨导联

移除使用桨状导线的脊髓刺激器, 外科医生在推荐十大正规网赌平台装置上方的背部做一个切口. This incision exposes the scar capsule that was created when the leads were initially implanted.

The surgeon opens that capsule to carefully detach the leads without disturbing the spinal cord. When the leads are out, the surgeon disconnects the device and removes all of the cabling. 这可能需要在脊髓上方的骨头上钻一个小窗口.

Then, the surgeon makes a second incision near the lower back or buttock to remove the device battery.

The procedure takes about 2 1/2 hours and is performed under general anesthesia.

脊髓刺激器移除恢复

移除脊髓刺激器后恢复得相当快. Most patients spend one night in the hospital for monitoring and return home the next day.

Surgical pain subsides faster in patients who have had percutaneous leads removed (after about a day) than in patients who had paddle leads taken out (around a week).

“在大多数情况下，我让推荐十大正规网赌平台随机应变. They can return to work and physical activity as soon as they’re feeling better but will need to avoid lifting anything over 20 pounds for about three weeks,安德森说。.

脊髓刺激器移除并发症

Complications of 脊髓刺激器 removal are rare, occurring in only 2–3% of procedures. Surgeons carefully screen patients to minimize the risk of these complications. 它们包括感染和脑脊液(CSF)泄漏.

• Any surgical procedure, including 脊髓刺激器 removal, carries the risk of 感染. 在你离开医院之前, your care team will provide instructions to keep your incisions clean to avoid 感染.
• 脑脊液漏 can occur when the surgeon opens the scar capsule that forms around the larger paddle leads. 操纵这个脆弱的区域会在硬脑膜上撕开一个小洞, 脊髓的最外层, 让一些液体泄漏出来. This complication is not usually life-threatening but often requires an additional surgery to repair.

脊髓刺激器移除后的疼痛处理

Patients whose stimulators have been removed will need to pursue other therapies to manage their chronic pain. 这些疗法可能包括:

• Cognitive behavioral therapy (CBT): CBT is a form of psychotherapy that teaches patients ways to cope with a variety of conditions, 包括慢性疼痛.
• Medications: Doctors are investigating more effective, less addictive medications for chronic pain. 有两种类型的药物显示出了希望:
  • Antidepressants: These drugs treat depression by changing how the nerve cells communicate with one another. 同样的机制可以改变身体传递疼痛信息的方式.
  • Antiepileptics: These medications are primarily used to prevent seizures but can also help calm faulty pain networks that are sending incorrect