短时程脊髓刺激术治疗脑损伤后慢性意识障碍（附100例报道）

Short-term spinal cord stimulation for chronic disorders of consciousness after brain injury: a report of 100 cases

摘要:

目的 分析短时程脊髓刺激术（stSCS）治疗脑损伤后慢性意识障碍患者的技术要点、临床诊疗价值，以及对微意识状态（MCS）患者的疗效。方法 回顾性总结长江航运总医院神经外科于2023年12月—2025年7月开展的100例接受stSCS治疗的慢性意识障碍患者（MCS 80例、植物状态20例），并纳入同期52例（MCS 42例、植物状态10例）基线匹配、未接受神经调控手术的患者作为对照组。手术采用全身麻醉，俯卧位，经皮经胸7～8椎间隙行硬脊膜外腔穿刺，DSA透视下将刺激电极顶端置入颈2～3水平；刺激4周，刺激参数为频率70 Hz，电压1～5 V；刺激小周期为开15 min，关15 min；刺激大周期为8点开机，20点关机。术后6个月随访，以昏迷恢复量表修订版（CRS-R）评分变化判定意识状态改善情况。结果 术后4周随访显示，50例患者意识状态得到有效改善（有效率50.0%）。术后6个月,82.0%的有效者维持改善效果。治疗期间仅1例出现穿刺部位轻微红肿，经局部换药后愈合，无严重并发症。结论 stSCS治疗慢性意识障碍微创、安全，对以MCS为主的患者具有明确临床价值，可作为慢性意识障碍患者促醒治疗的重要选择，手术中需重点关注电极置入准确性及参数调试合理性。

Abstract:

Objective To analyze the technical key points and clinical diagnostic and therapeutic value of short-term spinal cord stimulation （stSCS） in the treatment of patients with chronic disorders of consciousness after brain injury， with a focus on exploring the efficacy of this surgical method in patients with minimally conscious state.Methods A retrospective analysis was conducted on 100 patients with chronic disorders of consciousness （80 patients with minimally conscious state， 20 patients with vegetative state） who underwent stSCS at the Department of Neurosurgery， General Hospital of the Yangtze River Shipping， from December 2023 to July 2025. Additionally， 52 baseline-matched patients with chronic disorders of consciousness （42 patients with minimally conscious state， 10 patients with vegetative state） who did not receive neuromodulation surgery during the same period were included as the control group. Surgery was performed under general anesthesia with the patients in the prone position. A percutaneous epidural puncture was conducted via the T7-T8 intervertebral space， and the tip of the stimulation electrode was placed at the C2-C3 level under digital subtraction angiography fluoroscopy. The stimulation treatment lasted 4 weeks， with parameters set as follows： frequency 70 Hz； voltage 1-5 V； short stimulation cycle of 15 min on and 15 min off； long stimulation cycle of turning on at 8：00 and turning off at 20：00. Consciousness improvement was assessed by changes in the Coma Recovery Scale-Revised scores at 6 months post-surgery.Results The 4-week postoperative follow-up showed that consciousness was effectively improved in 50 patients， with a response rate of 50.0%. At 6 months post-surgery， 82.0% of the responders maintained the improvement. No serious complications occurred； only 1 patient developed mild redness and swelling at the puncture site， which healed after local dressing changes.Conclusions stSCS is minimally invasive and safe for the treatment of chronic disorders of consciousness， with clear clinical value for patients mainly with minimally conscious disorders. stSCS can be used as an important option for awakening treatment in patients with chronic disorders of consciousness. During surgery， special attention should be paid to the accuracy of electrode placement and the rationality of parameter adjustment.