Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
Neuromodulation. 2011 Jul-Aug;14(4):312-8; discussion 318. doi: 10.1111/j.1525-1403.2011.00372.x. Epub 2011 Jul 7.
Spinal cord stimulation (SCS) is frequently used to treat chronic, intractable back, and leg pain. Implantation can be accomplished with percutaneous leads or paddle leads. Although there is an extensive literature on SCS, the long-term efficacy, particularly with paddle leads, remains poorly defined. Outcome measure choice is important when defining therapeutic efficacy for chronic pain. Numerical rating scales such as the NRS-11 remain the most common outcome measure in the literature, although they may not accurately correlate with quality of life improvements and overall satisfaction.
We reviewed the medical records of patients with failed back surgery syndrome (FBSS) or complex regional pain syndrome (CRPS) implanted with SCS systems using paddle leads between 1997 and 2008 at the Cleveland Clinic with a minimum six-month follow-up. Patients were contacted to fill out a questionnaire evaluating outcomes with the NRS-11 as well as overall satisfaction.
A total of 35 eligible patients chose to participate. More than 50% of the patients with CRPS reported greater than 50% pain relief at a mean follow-up of 4.4 years. Approximately 30% of the FBSS patients reported a 50% or greater improvement at a mean follow-up of 3.8 years. However, 77.8% of patients with CRPS and 70.6% of patients with FBSS indicated that they would undergo SCS surgery again for the same outcome.
Patients with CRPS and FBSS have a high degree of satisfaction, indexed as willingness to undergo the same procedure again for the same outcome at a mean follow-up of approximately four years. The percentage of satisfaction with the SCS system is disproportionally greater than the percentage of patients reporting 50% pain relief, particularly among patients with FBSS. This suggests that the visual analog scale may not be the optimal measure to evaluate long-term outcomes in this patient population.
脊髓刺激（SCS）常用于治疗慢性、顽固性背痛和腿痛。植入可通过经皮导联或桨式导联完成。尽管 SCS 有广泛的文献记载，但长期疗效，特别是使用桨式导联的疗效，仍未得到明确界定。选择适当的衡量标准对于确定慢性疼痛的治疗效果非常重要。数字评定量表（如 NRS-11）仍然是文献中最常用的衡量标准，但它们可能无法准确反映生活质量的改善和整体满意度的提高。
我们回顾了 1997 年至 2008 年间在克利夫兰诊所使用桨式导联植入 SCS 系统的失败性脊柱手术综合征（FBSS）或复杂性区域疼痛综合征（CRPS）患者的病历，这些患者的随访时间至少为 6 个月。联系患者填写问卷，用 NRS-11 评估结果以及总体满意度。
共有 35 名符合条件的患者选择参与。CRPS 患者中有超过 50%的患者在平均 4.4 年的随访中报告疼痛缓解超过 50%。大约 30%的 FBSS 患者在平均 3.8 年的随访中报告疼痛改善 50%或更多。然而，77.8%的 CRPS 患者和 70.6%的 FBSS 患者表示，如果同样的结果，他们愿意再次接受 SCS 手术。
CRPS 和 FBSS 患者的满意度很高，这体现在他们愿意在平均约四年的随访中再次接受相同的手术来获得同样的结果。对 SCS 系统的满意度比例明显高于报告疼痛缓解 50%的患者比例，尤其是在 FBSS 患者中。这表明在这种患者群体中，视觉模拟评分可能不是评估长期结果的最佳衡量标准。
