De Groote Sander, Goudman Lisa, Linderoth Bengt, Buyck Félix, Rigoard Philippe, De Jaeger Mats, Van Schuerbeek Peter, Peeters Ronald, Sunaert Stefan, Moens Maarten
Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium.
Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium.
Pain Pract. 2020 Nov;20(8):878-888. doi: 10.1111/papr.12922. Epub 2020 Jun 26.
The effectiveness of spinal cord stimulation (SCS) as pain-relieving treatment for failed back surgery syndrome (FBSS) has already been demonstrated. However, potential structural and functional brain alterations resulting from subsensory SCS are less clear. The aim of this study was to test structural volumetric changes in a priori chosen regions of interest related to chronic pain after 1 month and 3 months of high-frequency SCS in patients with FBSS.
Eleven patients with FBSS who were scheduled for SCS device implantation were included in this study. All patients underwent a magnetic resonance imaging protocol before SCS device implantation 1 and 3 months after high-frequency SCS. Pain intensity, pain catastrophizing, and sleep quality were also measured. Regions-of-interest voxel-based morphometry was used to explore grey matter volumetric changes over time. Additionally, volumetric changes were correlated with changes in pain intensity, catastrophizing, and sleep quality.
Significant decreases were found in volume in the left and right hippocampus over time. More specifically, a significant difference was revealed between volumes before SCS implantation and after 3 months of SCS. Repeated-measures correlations revealed a significant positive correlation between volumetric changes in the left hippocampus and changes in back pain score over time and between volumetric changes in the right hippocampus and changes in back pain score over time.
In patients with FBSS, high-frequency SCS influences structural brain regions over time. The volume of the hippocampus was decreased bilaterally after 3 months of high-frequency SCS with a positive correlation with back pain intensity.
脊髓刺激（SCS）作为治疗失败的脊柱手术综合征（FBSS）的止痛方法，其有效性已得到证实。然而，亚感觉SCS导致的潜在脑结构和功能改变尚不清楚。本研究的目的是测试FBSS患者在高频SCS治疗1个月和3个月后，与慢性疼痛相关的预先选定感兴趣区域的结构体积变化。
本研究纳入了11例计划植入SCS设备的FBSS患者。所有患者在植入SCS设备前、高频SCS治疗1个月和3个月后均接受了磁共振成像检查。还测量了疼痛强度、疼痛灾难化程度和睡眠质量。采用基于体素的感兴趣区域形态学方法来探索灰质体积随时间的变化。此外，体积变化与疼痛强度、灾难化程度和睡眠质量的变化相关。
随着时间的推移，左右海马体体积显著减小。更具体地说，SCS植入前和SCS治疗3个月后的体积之间存在显著差异。重复测量相关性分析显示，左侧海马体体积变化与背痛评分随时间的变化之间以及右侧海马体体积变化与背痛评分随时间的变化之间存在显著正相关。
在FBSS患者中，高频SCS随时间影响脑结构区域。高频SCS治疗3个月后，双侧海马体体积减小，且与背痛强度呈正相关。
