PAIN RESEARCH
Online ISSN : 2187-4697
Print ISSN : 0915-8588
ISSN-L : 0915-8588
症例報告
頚胸椎移行部の脊髄刺激で両下肢体幹部の除痛が得られた１例
石内 崇勝, 細見 晃一, 森 信彦, 西 麻哉, 松橋 崇寛, 木本 優希, 岩田 貴光, 小野田 祐司, 江村 拓人, 三浦 慎平, 藤田 祐也, Khoo Hui Ming, 栁澤 琢史, 谷 直樹, 押野 悟, 貴島 晴彦
著者情報
キーワード: Spinal cord stimulation, Neuropathic pain, Dorsal column
ジャーナル フリー

2022 年 37 巻 2 号 p. 68-74

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We experienced a case in which stimulating the central side of the lesion successfully induced an extensive paresthesia at and below the spinal lesion, despite the severe sensory impairment in the same area. A woman in her 50s had a spinal tumor at T5–8 that was removed about 30 years ago. She had residual pain in both her lower extremities and the right side of the chest accompanied by a severe sensory disturbance below the T5 level, which were resistant to medication. She finally opted for an SCS to treat her neuropathic pain. During the stimulation trial, we placed a percutaneous cylindrical lead at the midline in the epidural space at C7–T2 through a puncture at T2–3. Tonic stimulation at T1–2 induced paresthesia at both sides in the axilla, trunk, and lower extremities, which has led to an improvement in the pain score from 10 to 7 (numerical rating scale; NRS). During the definitive implantation, we placed two cylindrical leads at the midline at C6–T2. With the same parameters as the trial stimulation, her pain score improved to 5 in NRS, which has led to an overall improvement of her quality of life, psychological conditions, and activity of daily living. Despite the severely damaged spinal sensory pathways and the broadly distributed pain area, it was possible to induce paresthesia and to achieve pain relief by stimulating the midline of the dorsal spinal cord and intact sensory pathways above the level of the spinal lesion.

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© 2022 日本疼痛学会
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