Demartini Laura, Terranova Gaetano, Innamorato Massimo A, Dario Alessandro, Sofia Michele, Angelini Carlo, Duse Genni, Costantini Amedeo, Leoni Matteo L G
Pain Unit, Clinical Scientific Institutes Maugeri, Pavia, Italy.
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Neuromodulation. 2019 Apr;22(3):327-332. doi: 10.1111/ner.12867. Epub 2018 Oct 17.
Spinal cord stimulation (SCS) is a well-known treatment in patients with failed back surgery syndrome (FBSS). Burst stimulation is a recently developed stimulation modality that seems to be superior to tonic stimulation.
This observational multicenter study compared tonic and burst stimulation during a trial period in patients with FBSS or radiculopathy. All the patients enrolled underwent two weeks of tonic stimulation followed by another two weeks of BurstDR stimulation, without randomization. The primary outcome was the reduction of pain in the legs and back. Health-related quality of life (EQ-5D) and the pain catastrophizing scale (PCS) were assessed before and after the trial. Patients were reevaluated after 12 months.
We recruited 23 patients, 57% of whom had FBSS and 43% had radiculopathies. Five patients failed both the tonic and burst stimulation trials. While tonic stimulation reduced leg pain (p < 0.05), the burst mode added an extra pain reduction (ΔNRS 1.2 ± 1.5) (p < 0.01). No significant reduction in back pain was found (p 0.29). Pain on movement was reduced only by BurstDR (p < 0.01). Both stimulation modalities increased EQ-5D and reduced PCS from the baseline (p < 0.0001). At the end of the SCS trial phase, 26% patients chose tonic SCS, while 74% preferred burst. On 12-month follow-up examination, the benefits recorded at the end of the trial were maintained.
Burst stimulation confers a greater reduction in leg pain intensity at rest and on movement. Reducing axial pain is still a challenge. Further studies are needed in order to provide each patient with the most appropriate stimulation paradigm.
脊髓刺激（SCS）是治疗腰椎手术失败综合征（FBSS）患者的一种知名疗法。爆发式刺激是一种最近开发的刺激方式，似乎优于强直性刺激。
这项观察性多中心研究比较了FBSS或神经根病患者在试验期内的强直性刺激和爆发式刺激。所有入组患者均接受了两周的强直性刺激，随后又接受了两周的BurstDR刺激，未进行随机分组。主要结局是腿部和背部疼痛的减轻。在试验前后评估了健康相关生活质量（EQ-5D）和疼痛灾难化量表（PCS）。12个月后对患者进行了重新评估。
我们招募了23名患者，其中57%患有FBSS，43%患有神经根病。5名患者在强直性刺激和爆发式刺激试验中均失败。虽然强直性刺激减轻了腿部疼痛（p<0.05），但爆发式模式额外减轻了疼痛（ΔNRS 1.2±1.5）（p<0.01）。未发现背痛有显著减轻（p=0.29）。仅BurstDR减轻了运动时的疼痛（p<0.01）。两种刺激方式均使EQ-5D升高，PCS较基线降低（p<0.0001）。在SCS试验阶段结束时，26%的患者选择了强直性SCS，而74%的患者更喜欢爆发式。在12个月的随访检查中，试验结束时记录的益处得以维持。
爆发式刺激在休息和运动时能更大程度地减轻腿部疼痛强度。减轻轴向疼痛仍然是一个挑战。需要进一步研究以便为每位患者提供最合适的刺激模式。
