Risson Erica Garbin, Serpa Ana Paula, Berger Jéssica Jacques, Koerbel Renata Fabiola Heil, Koerbel Andrei
Department of Medicine, University of Joinville Region, Joinville, Brazil.
Department of Intraoperative Monitoring - Neurological and Neurosurgical Clinic of Joinville, Brazil.
Clin Neurol Neurosurg. 2018 Aug;171:156-162. doi: 10.1016/j.clineuro.2018.06.014. Epub 2018 Jun 10.
Spinal cord stimulation has been proven highly effective in the treatment of Complex Regional Pain Syndrome (CRPS). The definitive implantation of a neurostimulator is usually preceded by a therapeutic test (trial), which has the purpose of identifying whether the patient would respond positively to neuromodulation or not. The present study aims to analyze the surgical results of spinal cord stimulation in type 1 CRPS patients who have not undergone trial.
From January 2011 to August 2017, 160 patients underwent implantation of spinal cord neurostimulator. Out of that total number of surgeries, 33 patients were unequivocally diagnosed with type 1 Complex Regional Pain Syndrome and selected for this study. The efficacy of the surgical procedure concerning pain improvement was analyzed through the application of the Pain Disability Index and the Visual Analog Pain Scale.
The mean sample age was 48.08 years. The majority of the study subjects were female (66.66%). In respect to the Pain Disability Index, a 65% improvement in disability was observed subsequently to the neurostimulator implantation; in addition, the means of the scores for preoperative and postoperative periods were, respectively, 55 ± 8.69 (p < 0.0001) and 18.90 ± 11.58 (p < 0.0001). Regarding the Visual Analogue Scale, the mean pain in the preoperative period was 9.43 ± 0.77 (p < 0.0001), while the mean in postoperative period was 2.86 ± 2.08 (p < 0.0001). Thus, an average reduction of 70% of painful symptoms was observed after the surgical procedure.
Implantation of a spinal cord neurostimulator presented significant improvement in pain and disability of patients with type 1 CRPS in all cases. These results were obtained following the criteria: 1) patients presenting unequivocal diagnosis of type 1 CRPS; 2) submitted to constant current spinal cord neurostimulator implant; 3) underwent intraoperative tests for precise location of the spinal cord electrode implantation. Therefore, it is possible to suggest that a trial may be unnecessary in that subgroup of patients. Further studies would be required to confirm these findings.
脊髓刺激已被证明在治疗复杂性区域疼痛综合征（CRPS）方面非常有效。在最终植入神经刺激器之前，通常会进行一次治疗性测试（试验），其目的是确定患者对神经调节是否会产生积极反应。本研究旨在分析未进行试验的1型CRPS患者脊髓刺激的手术结果。
2011年1月至2017年8月，160例患者接受了脊髓神经刺激器植入手术。在所有手术中，33例患者被明确诊断为1型复杂性区域疼痛综合征，并被选入本研究。通过应用疼痛残疾指数和视觉模拟疼痛量表分析手术治疗疼痛改善的疗效。
样本平均年龄为48.08岁。大多数研究对象为女性（66.66%）。关于疼痛残疾指数，神经刺激器植入后观察到残疾改善了65%；此外，术前和术后评分的平均值分别为55±8.69（p<0.0001）和18.90±11.58（p<0.0001）。关于视觉模拟量表，术前平均疼痛为9.43±0.77（p<0.0001），而术后平均疼痛为2.86±2.08（p<0.0001）。因此，手术后观察到疼痛症状平均减轻了70%。
在所有病例中，脊髓神经刺激器植入对1型CRPS患者的疼痛和残疾状况有显著改善。这些结果是按照以下标准获得的：1）明确诊断为1型CRPS的患者；2）接受恒流脊髓神经刺激器植入；3）术中进行脊髓电极植入精确定位测试。因此，可以认为在该亚组患者中可能不需要进行试验。需要进一步的研究来证实这些发现。
