Hunter Corey W, Carlson Jonathan, Yang Ajax, Deer Timothy
Ainsworth Institute of Pain Management, New York, NY, USA.
Arizona Pain, Glendale, AZ, USA.
Neuromodulation. 2018 Jul;21(5):495-503. doi: 10.1111/ner.12769. Epub 2018 Mar 22.
Spinal cord stimulation (SCS) is an accepted, cost-effective treatment option for a variety of chronic pain syndromes, including failed back surgery syndrome (FBSS). The application of SCS in the cervical spine, particularly for pain after cervical spine surgery, has been drawn into question in recent years by payers due to a purported lack of clinical evidence. To challenge this claim, we analyzed data from a prospective registry to support the use of SCS in the cervical spine for pain after spine surgery.
Data from the EMPOWER and PAIN registries were analyzed on patients diagnosed with pain after neck surgery (C-FBSS) for the following outcomes: patient reported percent pain relief (PRPR), pain disability index (PDI), quality of life (QoL), and satisfaction at 3-, 6-, and 12-month post-implantation. Statistical analysis was provided for all measures.
Fifteen patients with C-FBSS were successfully implanted with SCS leads in the cervical spine. PRPR was 65.2%, 62.4%, and 71.9% at 3-, 6-, and 12-month post-implantation, respectively. PDI scores were significantly reduced from baseline (51.21-23.70 at 12 months, p = 0.001). At one-year post-implantation, the average overall QoL was reported to be improved/greatly improved and patient satisfaction was rated satisfied/greatly satisfied.
For many, the application of SCS in the neck for pain after surgery is based on the obvious similarities to FBSS or anecdotal experience rather than published data. The data contained herein suggest SCS for C-FBSS is an effective therapy that improves QoL and patient satisfaction, as well as decreasing pain and PDI. The use of successful application of neurostimulation as a therapy has largely been predicated on the principles of patient selection, implantation technique, and stimulation parameters. As such, SCS would appear to be an appropriate and valid treatment for C-FBSS that requires further study and investigation to make additional recommendations.
脊髓刺激（SCS）是一种被认可的、具有成本效益的治疗多种慢性疼痛综合征的方法，包括腰椎手术失败综合征（FBSS）。近年来，由于据称缺乏临床证据，医保支付方对SCS在颈椎的应用，尤其是颈椎手术后疼痛的应用提出了质疑。为了挑战这一说法，我们分析了来自前瞻性注册研究的数据，以支持SCS在颈椎用于脊柱手术后疼痛的应用。
对EMPOWER和PAIN注册研究中诊断为颈部手术后疼痛（C-FBSS）患者的数据进行分析，以观察以下结果：患者报告的疼痛缓解百分比（PRPR）、疼痛残疾指数（PDI）、生活质量（QoL）以及植入后3个月、6个月和12个月时的满意度。对所有测量指标进行了统计分析。
15例C-FBSS患者成功在颈椎植入SCS电极。植入后3个月、6个月和12个月时的PRPR分别为65.2%、62.4%和71.9%。PDI评分从基线显著降低（12个月时从51.21降至23.70，p = 0.001）。植入后一年，报告的平均总体生活质量为改善/大大改善，患者满意度评为满意/非常满意。
对许多人来说，SCS在颈部用于手术后疼痛的应用是基于与FBSS的明显相似性或轶事经验，而非已发表的数据。本文中的数据表明，SCS用于C-FBSS是一种有效的治疗方法，可改善生活质量和患者满意度，同时减轻疼痛和降低PDI。神经刺激作为一种治疗方法的成功应用很大程度上取决于患者选择、植入技术和刺激参数的原则。因此，SCS似乎是C-FBSS的一种合适且有效的治疗方法，需要进一步研究和调查以提出更多建议。
