Adena Spine Center , Chillicothe, OH, USA.
Pain Treatment Centers of America , Little Rock, AR, USA.
Expert Rev Med Devices. 2020 Dec;17(12):1293-1302. doi: 10.1080/17434440.2020.1801411. Epub 2020 Sep 29.
Spinal cord stimulation (SCS) is an effective treatment for chronic, intractable neuropathic pain. There have been relatively few high-level studies that suggest its unequivocal use. The decay of stimulation efficacy over time have opened opportunity for the entrance of new pulse trains and waveforms.
In this state-of-the-art review, we focused on many of the major studies published in the last 10 years that were considered level one evidence. A retrospective narrative approach was taken to conceptualize foundation studies as they pertain to current evidence. A special focus was taken on reported safety outcomes in comparison to foundation studies especially as they pertain to our 5-year outlook on the use of spinal cord stimulation.
We find there are still significant limitations in the body of reviewed evidence and suggest that long-term data beyond 24 months are lacking in the literature. In addition, adverse event rates, device explantation rates and the sham effect looms as important concepts to address in the future in spite of the existing novel stimulation paradigms.
脊髓刺激（SCS）是一种治疗慢性、难治性神经性疼痛的有效方法。虽然有一些相对高级别的研究表明了其确切疗效，但随着时间的推移，刺激效果会逐渐减弱，这为新的脉冲序列和波形的引入提供了机会。
在这篇最新综述中，我们主要关注了过去 10 年中发表的许多被认为是一级证据的主要研究。我们采用回顾性叙述方法来构思基础研究，因为它们与当前的证据有关。特别关注了与基础研究相比报告的安全性结果，特别是因为它们与我们对脊髓刺激使用的 5 年展望有关。
我们发现，在审查的证据中仍然存在重大局限性，并且认为文献中缺乏超过 24 个月的长期数据。此外，尽管存在新的刺激模式，但不良事件发生率、设备取出率和假手术效应仍然是未来需要解决的重要问题。
