Chinese expert consensus on spinal cord stimulation for post-stroke hemiplegia (2025 edition)

doi:10.3877/cma.j.issn.2095-123X.2026.01.002

Abstract

Abstract:

Approximately 70%-80% of stroke survivors experience residual hemiplegic motor dysfunction, significantly impairing their capacity for activities of daily life. Current therapeutic modalities for post-stroke hemiplegia primarily include pharmacological interventions, rehabilitation therapies, and orthopedic surgical procedures; however, these conventional approaches exhibit notable limitations. Spinal cord stimulation (SCS), which involves precise epidural electrode implantation to modulate spinal and cerebral neural network activity, has demonstrated preliminary safety and efficacy in improving motor function. This consensus document systematizes and summarizes key aspects of SCS implementation for post-stroke hemiplegia, including surgical indications, optimal timing, preoperative assessment, surgical techniques, parameter configuration, postoperative management, and rehabilitation protocols. The objective is to establish standardized protocols to facilitate the widespread adoption of this therapeutic technology.

Key words: Stroke, Hemiplegia, Spinal cord stimulation, Expert consensus

Chinese Expert Consensus Writing Group on Spinal Cord Stimulation for Post-Stroke Hemiplegia, Functional Neurosurgery Group, Neurosurgery Branch of Chinese Medical Association, Neurosurgery Professional Committee, Chinese Research Hospital Association, Functional Neurosurgery Professional Committee, World Chinese Neurosurgical Association, Functional Neurosurgery Professional Group, Neurosurgery Branch of Beijing Medical Association, Peripheral Nerve Surgery Professional Group, Neurosurgery Branch of Beijing Medical Association. Chinese expert consensus on spinal cord stimulation for post-stroke hemiplegia (2025 edition)[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2026, 16(01): 8-18.

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并发症	病因、机制及表现	防治措施
脊髓损伤	电极植入硬脊膜外腔时误伤脊髓，导致术后运动或感觉功能障碍	术前完善相关检查，对于已有严重椎管狭窄的脊柱节段必要时扩大椎板切除范围；操作轻柔，避免暴力植入电极；一旦发生严重脊髓损伤伴水肿，患者出现截瘫表现，应根据患者病情急诊手术去除电极或加行椎板切除减压
椎管内血肿	植入电极时可能损伤硬脊膜外血管，甚至引发血肿压迫脊髓，术后表现为肢体疼痛、无力、感觉减退等	术前认真评估凝血功能，良好控制血压；术中避免暴力操作，植入完成后术区彻底止血并逐层严密缝合组织；对于血肿较大、压迫脊髓严重者应急诊手术清除血肿减压
椎管内感染	表现为局部发热、切口红肿、疼痛剧烈，严重时可出现脑膜刺激征和截瘫	严格无菌操作；围术期预防性使用抗生素；术中植入电极前局部充分冲洗；术后定期换药，密切观察伤口情况；良好控制血糖；发生感染后及时获取病原学证据，足量、足疗程应用敏感抗生素；当感染不可控时，通常需要去除植入物
脑脊液漏	多因放置电极时粗暴操作或遇有硬脊膜外黏连造成硬脊膜破损，术中见脑脊液流出即可确认；术后可表现为体位性头痛、切口大量渗液，严重时可导致颅内感染	术中轻柔操作，避免多次、反复穿刺；术后一旦发现脑脊液漏应暂缓开机，去枕平卧，预防感染，必要时补液治疗
植入物排异反应	植入物（电极、导线、IPG）作为异物，因个体差异可能引发局部无菌性炎症或排异反应，表现为术后早期即发生切口类似炎症反应、不愈合，甚至植入物排出	密切观察切口情况，必要时去除植入物
电极移位	多发生于经皮穿刺电极术后活动不当或体位急剧改变时，表现为刺激效果减弱或消失，目标区域刺激覆盖不满意；外科电极移位者罕见	术后2周内以平卧或患侧卧为主，避免剧烈运动；术后出现电刺激覆盖区域改变或效果减弱应立即行影像学复查，必要时再次手术调整电极位置
电极导线断裂	电极导线长期受机械应力作用或磨损后可能断裂，表现为刺激中断或异常、设备报警	术中固定导线时预留长度、制作应力消除环，避免导线走行过程中出现过大弯曲甚至锐角折叠，术后避免过度剧烈活动和突然变换体位
切口并发症	切口感染、血肿、不愈合等	防治措施同椎管内感染
囊袋并发症	IPG植入囊袋可能出现感染、血肿、皮肤破溃、IPG外露、IPG移位	选择合适的植入部位及深度，避免皮肤张力过高；术中将IPG与局部肌筋膜缝合固定，避免术后因重力而下移；术后密切观察囊袋情况

并发症	病因、机制及表现	防治措施
脊髓损伤	电极植入硬脊膜外腔时误伤脊髓，导致术后运动或感觉功能障碍	术前完善相关检查，对于已有严重椎管狭窄的脊柱节段必要时扩大椎板切除范围；操作轻柔，避免暴力植入电极；一旦发生严重脊髓损伤伴水肿，患者出现截瘫表现，应根据患者病情急诊手术去除电极或加行椎板切除减压
椎管内血肿	植入电极时可能损伤硬脊膜外血管，甚至引发血肿压迫脊髓，术后表现为肢体疼痛、无力、感觉减退等	术前认真评估凝血功能，良好控制血压；术中避免暴力操作，植入完成后术区彻底止血并逐层严密缝合组织；对于血肿较大、压迫脊髓严重者应急诊手术清除血肿减压
椎管内感染	表现为局部发热、切口红肿、疼痛剧烈，严重时可出现脑膜刺激征和截瘫	严格无菌操作；围术期预防性使用抗生素；术中植入电极前局部充分冲洗；术后定期换药，密切观察伤口情况；良好控制血糖；发生感染后及时获取病原学证据，足量、足疗程应用敏感抗生素；当感染不可控时，通常需要去除植入物
脑脊液漏	多因放置电极时粗暴操作或遇有硬脊膜外黏连造成硬脊膜破损，术中见脑脊液流出即可确认；术后可表现为体位性头痛、切口大量渗液，严重时可导致颅内感染	术中轻柔操作，避免多次、反复穿刺；术后一旦发现脑脊液漏应暂缓开机，去枕平卧，预防感染，必要时补液治疗
植入物排异反应	植入物（电极、导线、IPG）作为异物，因个体差异可能引发局部无菌性炎症或排异反应，表现为术后早期即发生切口类似炎症反应、不愈合，甚至植入物排出	密切观察切口情况，必要时去除植入物
电极移位	多发生于经皮穿刺电极术后活动不当或体位急剧改变时，表现为刺激效果减弱或消失，目标区域刺激覆盖不满意；外科电极移位者罕见	术后2周内以平卧或患侧卧为主，避免剧烈运动；术后出现电刺激覆盖区域改变或效果减弱应立即行影像学复查，必要时再次手术调整电极位置
电极导线断裂	电极导线长期受机械应力作用或磨损后可能断裂，表现为刺激中断或异常、设备报警	术中固定导线时预留长度、制作应力消除环，避免导线走行过程中出现过大弯曲甚至锐角折叠，术后避免过度剧烈活动和突然变换体位
切口并发症	切口感染、血肿、不愈合等	防治措施同椎管内感染
囊袋并发症	IPG植入囊袋可能出现感染、血肿、皮肤破溃、IPG外露、IPG移位	选择合适的植入部位及深度，避免皮肤张力过高；术中将IPG与局部肌筋膜缝合固定，避免术后因重力而下移；术后密切观察囊袋情况

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