The Center for Pain Relief, Charleston, WV, USA.
Neuromodulation. 2014 Apr;17(3):265-71; discussion 271. doi: 10.1111/ner.12119. Epub 2013 Sep 24.
Scientific evidence supports spinal cord stimulation (SCS) as a cost-effective treatment option that, for many disease states, should be employed earlier in the treatment continuum. Reimbursement for SCS in the cervical spine has recently been challenged based on supposed lack of clinical literature. To refute this assumption, we analyzed data from an international registry to support the use of cervical SCS.
The following outcomes were collected as part of an institutional review board-approved, prospective, multicenter, international registry: pain relief, Pain Disability Index (PDI) score, quality of life (QoL), and satisfaction at 3, 6, and 12 months post-implantation. Descriptive statistics are provided for all measures. Changes from baseline in PDI scores were analyzed using Tukey's pairwise comparisons.
Thirty-eight patients underwent implantation of SCS leads in the cervical spine at 16 study sites in the United States and 3 international study sites. Direct patient report of percentage of pain relief was 54.2%, 60.2%, and 66.8% at 3, 6, and 12 months post-implantation, respectively. Pain relief was categorized as excellent/good by 61.6% of patients at 3 months, with similar results observed at 6 and 12 months. PDI scores were significantly reduced at all time points. At 3 months post-implantation, 92.4% of patients indicated they were very satisfied/satisfied with the SCS device. No patients indicated that they were dissatisfied. Overall QoL was reported as improved/greatly improved by 73.1% of patients at 3 months. Similar results for QoL and satisfaction were reported at 6 and 12 months.
The results suggest that the use of SCS in the cervical spine is a medically effective method of pain management that satisfies and improves the QoL of most patients. The use of SCS can reduce the high cost of direct medical treatment of pain, as well as increasing the productivity of patients, and therefore should be reimbursed in appropriately selected patients.
科学证据支持脊髓刺激（SCS）作为一种具有成本效益的治疗选择，对于许多疾病状态，应该在治疗连续体的早期采用。最近，由于据称缺乏临床文献，颈椎 SCS 的报销受到了质疑。为了反驳这一假设，我们分析了来自国际登记处的数据，以支持颈椎 SCS 的使用。
以下结果是作为机构审查委员会批准的、前瞻性的、多中心的国际登记处的一部分收集的：疼痛缓解、疼痛残疾指数（PDI）评分、生活质量（QoL）和植入后 3、6 和 12 个月的满意度。所有措施均提供描述性统计。使用 Tukey 的两两比较分析 PDI 评分从基线的变化。
38 名患者在美国的 16 个研究地点和 3 个国际研究地点植入了 SCS 导联。直接报告的疼痛缓解百分比分别为植入后 3、6 和 12 个月的 54.2%、60.2%和 66.8%。61.6%的患者在 3 个月时将疼痛缓解评为优秀/良好，在 6 个月和 12 个月时也观察到类似的结果。PDI 评分在所有时间点均显著降低。植入后 3 个月，92.4%的患者表示对 SCS 装置非常满意/满意。没有患者表示不满意。73.1%的患者在植入后 3 个月报告总体 QoL 得到改善/大大改善。在 6 个月和 12 个月时，QoL 和满意度也报告了类似的结果。
结果表明，颈椎 SCS 的使用是一种有效的疼痛管理方法，可以满足大多数患者的需求并提高他们的生活质量。SCS 的使用可以降低直接治疗疼痛的高昂医疗费用，同时提高患者的生产力，因此应在适当选择的患者中报销。
