From the Orthopaedic Institute, Allegheny Health Network, Pittsburgh, PA.
J Am Acad Orthop Surg. 2019 May 1;27(9):e401-e407. doi: 10.5435/JAAOS-D-17-00829.
Chronic pain causes a tremendous burden on the society in terms of economic factors and social costs. Rates of spinal surgery, especially spinal fusion, have increased exponentially over the past decade. The opioid epidemic in the United States has been one response to the management of pain, but it has been fraught with numerous catastrophic-related adverse effects. Clinically, spinal cord stimulation (SCS)/neuromodulation has been used in the management of chronic pain (especially spine-related pain) for more than two decades. More recent advances in this field have led to new theories and approaches in which SCS can be used in the management of chronic spine-related pain with precision and efficacy while minimizing adverse effects commonly seen with other forms of chronic pain treatment (eg, narcotics, injections, ablations). Narcotic medications have adverse effects of habituation, nausea, constipation, and the like. Injections sometimes lack efficacy and can have only limited duration of efficacy. Also, they can have adverse effects of cerebrospinal fluid leak, infection, and so on. Ablations can be associated with burning discomfort, lack of efficacy, recurrent symptoms, and infection. High-frequency stimulation, burst stimulation, tonic stimulation with broader paddles, and new stimulation targets such as the dorsal root ganglion hold promise for improved pain management via neuromodulation moving forward. Although a significant rate of complications with SCS technology are well described, this can be a useful tool in the management of chronic spine-related pain.
慢性疼痛给社会带来了巨大的经济负担和社会成本。在过去十年中，脊柱手术（尤其是脊柱融合术）的比例呈指数级增长。美国的阿片类药物泛滥是治疗疼痛的一种反应，但它带来了许多灾难性的不良反应。临床上，脊髓刺激（SCS）/神经调节已用于慢性疼痛（尤其是与脊柱相关的疼痛）的管理超过二十年。该领域的最新进展带来了新的理论和方法，SCS 可以用于管理慢性脊柱相关疼痛，具有精确性和疗效，同时最大限度地减少其他形式的慢性疼痛治疗（如麻醉药、注射、消融）常见的不良反应。麻醉药物有习惯、恶心、便秘等不良反应。注射有时缺乏疗效，疗效持续时间有限。此外，它们还可能有脑脊液漏、感染等不良反应。消融可能会引起烧灼感、疗效不佳、症状复发和感染。高频刺激、爆发刺激、使用更宽的刺激器进行持续刺激以及新的刺激靶点（如背根神经节）为通过神经调节改善疼痛管理带来了希望。尽管 SCS 技术存在较高的并发症发生率，但它仍是治疗慢性脊柱相关疼痛的有效工具。
