Teton Zoe E, Blatt Daniel, AlBakry Amr, Obayashi James, Ozturk Gulsah, Hamzaoglu Vural, Magown Philippe, Selden Nathan R, Burchiel Kim J, Raslan Ahmed M
J Neurosurg. 2019 Apr 19;132(5):1385-1391. doi: 10.3171/2019.2.JNS182450. Print 2020 May 1.
Despite rapid development and expansion of neuromodulation technologies, knowledge about device and/or therapy durability remains limited. The aim of this study was to evaluate the long-term rate of hardware and therapeutic failure of implanted devices for several neuromodulation therapies.
The authors performed a retrospective analysis of patients' device and therapy survival data (Kaplan-Meier survival analysis) for deep brain stimulation (DBS), vagus nerve stimulation (VNS), and spinal cord stimulation (SCS) at a single institution (years 1994-2015).
During the study period, 450 patients underwent DBS, 383 VNS, and 128 SCS. For DBS, the 5- and 10-year initial device survival was 87% and 73%, respectively, and therapy survival was 96% and 91%, respectively. For VNS, the 5- and 10-year initial device survival was 90% and 70%, respectively, and therapy survival was 99% and 97%, respectively. For SCS, the 5- and 10-year initial device survival was 50% and 34%, respectively, and therapy survival was 74% and 56%, respectively. The average initial device survival for DBS, VNS, and SCS was 14 years, 14 years, and 8 years while mean therapy survival was 18 years, 18 years, and 12.5 years, respectively.
The authors report, for the first time, comparative device and therapy survival rates out to 15 years for large cohorts of DBS, VNS, and SCS patients. Their results demonstrate higher device and therapy survival rates for DBS and VNS than for SCS. Hardware failures were more common among SCS patients, which may have played a role in the discontinuation of therapy. Higher therapy survival than device survival across all modalities indicates continued therapeutic benefit beyond initial device failures, which is important to emphasize when counseling patients.
尽管神经调节技术迅速发展并不断扩展，但关于设备和/或治疗耐久性的知识仍然有限。本研究的目的是评估几种神经调节治疗中植入设备的硬件和治疗失败的长期发生率。
作者对一家机构（1994年至2015年）中接受深部脑刺激（DBS）、迷走神经刺激（VNS）和脊髓刺激（SCS）的患者的设备和治疗生存数据进行了回顾性分析（Kaplan-Meier生存分析）。
在研究期间，450例患者接受了DBS，383例接受了VNS，128例接受了SCS。对于DBS，5年和10年的初始设备生存率分别为87%和73%，治疗生存率分别为96%和91%。对于VNS，5年和10年的初始设备生存率分别为90%和70%，治疗生存率分别为99%和97%。对于SCS，5年和10年的初始设备生存率分别为50%和34%，治疗生存率分别为74%和56%。DBS、VNS和SCS的平均初始设备生存时间分别为14年、14年和8年，而平均治疗生存时间分别为18年、18年和12.5年。
作者首次报告了大量DBS、VNS和SCS患者长达15年的设备和治疗生存率比较情况。他们的结果表明，DBS和VNS的设备和治疗生存率高于SCS。硬件故障在SCS患者中更为常见，这可能在治疗中断中起到了作用。所有模式下治疗生存率高于设备生存率表明，在初始设备故障后仍有持续的治疗益处，这在为患者提供咨询时需要重点强调。
