Kinfe Thomas M, Muhammad Sajjad, Link Carolina, Roeske Sandra, Chaudhry Shafqat R, Yearwood Thomas L
Department of Neurosurgery, Rheinische Friedrich Wilhelms - University Hospital, Bonn, Germany.
Division of Functional Neurosurgery and Neuromodulation, Rheinische Friedrich Wilhelms - University Hospital, Bonn, Germany.
Neuromodulation. 2017 Jun;20(4):322-330. doi: 10.1111/ner.12586. Epub 2017 Feb 13.
Burst spinal cord stimulation (SCS) has been reported to reduce back pain and improve functional capacity in Failed Back Surgery Syndrome (FBSS). However, its mechanism of action is not completely understood. Systemic circulating cytokines have been associated with the development of chronic back pain.
This prospective, feasibility study enrolled 12 refractory FBSS patients with predominant back pain (70% of overall pain) suitable for Burst SCS. Back and leg pain intensity (back pain [VAS ]/leg pain [VAS ]), functional capacity (sleep quality [PSQI]), depressive symptoms (BDI), body weight, stimulation parameters, and plasma levels of pro-inflammatory (Il-1b; TNF; HMGB1)/anti-inflammatory (Il-10) cytokines were collected at baseline and after three months of Burst SCS and compared to healthy controls.
Pain intensity (pre VAS : 8.25 ± 0.75 vs. post 1.42 ± 1.24) and functional capacity (PSQI: pre 7.92 ± 3.92 vs. post 3.42 ± 1.24; BDI: pre 20.83 ± 3.56 vs. post 10.92 ± 0.75) significantly improved compared to baseline. Pro-inflammatory HMGB1 remained unchanged (preburst: 3.35 ± 3.25 vs. postburst: 3.78 ± 3.83 ng/mL; p = 0.27; W = -30) versus the HC group (2.53 ± 2.6 ng/mL; p = 0.47; U = 59), while anti-inflammatory IL-10 levels were significantly elevated after burst SCS as compared to baseline (preburst 12.54 ± 22.95 vs. postburst 43.16 ± 74.71 pg/mL; p = 0.03; W = -48) and HC group (HC: 7.03 ± 11.6 vs. postburst 43.16 ± 74.71 pg/mL; p = 0.03; W = -48; p = 0.04). Baseline preburst IL-10 values and preburst VAS significantly correlated (Spearman correlation r = -0.66; p = 0.05; 95 CI -0.86 to -0.24), while correlation was not significant between postburst IL-10 values and postburst VAS (Spearman correlation r = -0.49; p = 0.18; 95 CI -0.83 to -0.15). Postburst IL-10 values correlated significantly with postburst PSQI scores (Spearman correlation r = -0.66; p = 0.05; 95 CI -0.86 to -0.24), while no correlation was found between preburst and postburst changes related to the BDI.
Burst SCS increased systemic circulating anti-inflammatory IL-10, improved FBSS back pain and back pain associated co-morbidities like disrupted sleep architecture and depressive symptoms in FBSS patients. Thus, suggesting a possible relationship between burst SCS and burst-evoked modulation of peripheral anti-inflammatory cytokine IL-10 in chronic back pain.
据报道，脉冲脊髓刺激（SCS）可减轻失败的脊柱手术综合征（FBSS）患者的背痛并改善其功能能力。然而，其作用机制尚未完全明确。全身循环细胞因子与慢性背痛的发生有关。
这项前瞻性可行性研究纳入了12例以背痛为主（占总疼痛的70%）且适合脉冲SCS的难治性FBSS患者。在基线时以及脉冲SCS治疗三个月后，收集患者的背部和腿部疼痛强度（背痛[视觉模拟评分法（VAS）]/腿痛[VAS]）、功能能力（睡眠质量[匹兹堡睡眠质量指数（PSQI）]）、抑郁症状（贝克抑郁量表[BDI]）、体重、刺激参数以及促炎（白细胞介素-1β[Il-1b]；肿瘤坏死因子[TNF]；高迁移率族蛋白B1[HMGB1]）/抗炎（白细胞介素-10[Il-10]）细胞因子的血浆水平，并与健康对照进行比较。
与基线相比，疼痛强度（术前VAS：8.25±0.75 vs.术后1.42±1.24）和功能能力（PSQI：术前7.92±3.92 vs.术后3.42±1.24；BDI：术前20.83±3.56 vs.术后10.92±0.75）显著改善。与健康对照组（2.53±2.6 ng/mL；p=0.47；U=59）相比，促炎HMGB1保持不变（脉冲前：3.35±3.25 vs.脉冲后：3.78±3.83 ng/mL；p=0.27；W=-30），而抗炎Il-10水平在脉冲SCS后与基线相比显著升高（脉冲前12.54±22.95 vs.脉冲后43.16±74.71 pg/mL；p=0.03；W=-48），且与健康对照组相比也显著升高（健康对照组：7.03±11.6 vs.脉冲后43.16±74.71 pg/mL；p=0.03；W=-48；p=0.04）。基线脉冲前Il-10值与脉冲前VAS显著相关（斯皮尔曼相关系数r=-0.66；p=0.05；95%置信区间-0.86至-0.24），而脉冲后Il-10值与脉冲后VAS之间的相关性不显著（斯皮尔曼相关系数r=-0.49；p=0.18；95%置信区间-0.83至-0.15）。脉冲后Il-10值与脉冲后PSQI评分显著相关（斯皮尔曼相关系数r=-0.66；p=0.05；95%置信区间-0.86至-0.24），而在脉冲前和脉冲后与BDI相关的变化之间未发现相关性。
脉冲SCS增加了全身循环的抗炎Il-10，改善了FBSS患者的背痛以及与背痛相关的合并症，如睡眠结构紊乱和抑郁症状。因此，提示脉冲SCS与慢性背痛中脉冲诱发的外周抗炎细胞因子Il-10的调节之间可能存在关联。
