Huygen Frank, Liem Liong, Cusack William, Kramer Jeffery
Erasmus University, Rotterdam, Maastricht, The Netherlands.
Maastricht University Medical Centre, Maastricht, The Netherlands.
Pain Pract. 2018 Feb;18(2):205-213. doi: 10.1111/papr.12591. Epub 2017 Dec 6.
Chronic low back pain affects millions of people worldwide and can arise through a variety of clinical origins. In the case of failed back surgery syndrome (FBSS), previous surgical procedures can contribute to low back pain that is often unresponsive to intervention. Although spinal cord stimulation (SCS) can be an effective treatment modality, it does not provide sufficient pain relief for some intractable cases. Recently, alternative neuromodulation options have been developed, including dorsal root ganglion (DRG) stimulation. The objective of this report is to further investigate these clinical observations.
Twelve patients with significant chronic discogenic low back pain due to FBSS were included. All subjects underwent implantation of DRG stimulation systems that had at least 1 lead placed at L2 or L3. Subjects' pain ratings, mood, and quality of life were tracked prospectively for up to 12 months.
More than half of subjects reported 50% or better pain relief in the low back, and the average low back pain relief was 45.5% at 12 months. Concomitant reductions in overall pain, leg pain, pain interference, mood, and quality of life were also found.
For the studied population, DRG stimulation at the L2-L3 levels was effective at relieving low back pain. These reductions in pain were associated with improvements in quality of life. Thus, DRG stimulation at these levels may be effective for low back pain by recruiting both segmental and nonsegmental neural pathways that are not otherwise accessible via traditional SCS.
慢性下腰痛影响着全球数百万人，其产生可能源于多种临床病因。对于腰椎手术失败综合征（FBSS）而言，先前的手术操作可能导致下腰痛，而这种疼痛通常对干预措施无反应。尽管脊髓刺激（SCS）可能是一种有效的治疗方式，但对于某些顽固性病例，它并不能提供足够的疼痛缓解。最近，已开发出包括背根神经节（DRG）刺激在内的替代性神经调节选项。本报告的目的是进一步研究这些临床观察结果。
纳入了12例因FBSS导致严重慢性椎间盘源性下腰痛的患者。所有受试者均接受了DRG刺激系统植入，其中至少有一根电极置于L2或L3水平。对受试者的疼痛评分、情绪和生活质量进行了长达12个月的前瞻性跟踪。
超过一半的受试者报告下腰痛缓解了50%或更多，12个月时平均下腰痛缓解率为45.5%。还发现总体疼痛、腿痛、疼痛干扰、情绪和生活质量也随之降低。
对于所研究的人群，L2-L3水平的DRG刺激在缓解下腰痛方面是有效的。这些疼痛的减轻与生活质量的改善相关。因此，这些水平的DRG刺激可能通过募集传统SCS无法触及的节段性和非节段性神经通路来有效缓解下腰痛。
