Neurological Surgery 脳神経外科41巻10号

2013年10月発行

総説

脊髄刺激療法再考

著者： 上利崇¹ 伊達勲¹

所属機関： ¹岡山大学大学院医歯薬学総合研究科脳神経外科

ページ範囲：P.851 - P.874

Ⅰ．はじめに

　脊髄刺激療法（spinal cord stimulation：SCS）は，難治性の慢性疼痛に対する治療として，脊髄硬膜外腔に電極を留置し，脊髄後索を中心に電気刺激を行い，疼痛の緩和を図る治療法である．1965年のMelzackとWallのgate control theoryに基づき⁹³⁾．1967年，Shealyらにより末期癌患者に対して，後索刺激が行われたのが最初である¹²⁶⁾．最初の10年間は，SCSの成功率は低く，その理由として十分な患者選択が行われておらず，刺激療法自体に技術的な限界があったことが挙げられる．本邦では，SCSは1998年に保険収載となり，薬物治療，一般的外科治療が困難な難治性疼痛に対して行われてきた．近年，脊髄刺激装置や硬膜外刺激電極の新しいデバイスが次々に開発され，複雑な疼痛部位に対しても，適切な電気刺激を行えるようになり，治療成績の向上および適応疾患の拡大²⁾が期待される．

　本稿では，SCS再考と題し，SCSの作用機序，手術適応および治療効果について最近の文献をレビューし，当科での治療経験とともにSCSの有効性と問題点，今後の展望について解説する．

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