Department of Neurosurgery, Albany Medical Center, Albany, New York, USA.
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA.
World Neurosurg. 2020 Nov;143:e442-e449. doi: 10.1016/j.wneu.2020.07.187. Epub 2020 Aug 1.
Some patients with chronic pain and implanted spinal cord stimulators or intrathecal (IT) pumps fail to obtain significant pain relief. The use of dual modality treatment with both therapies is understudied. This study evaluated comprehensive outcomes in this patient population and reported outcomes primarily using IT ziconotide.
We retrospectively analyzed 11 patients with chronic pain treated with both spinal cord stimulation and IT therapy. When a primary treatment failed to achieve significant pain relief, a secondary device was trialed and implanted. Pain severity (measured by a numeric rating scale) was assessed by the change from baseline to after the first and second intervention. In a subset of patients (n = 6), quality-of-life metrics were also assessed. Outcome measures were analyzed closest to the 1-year follow-up date after implantation of the first modality and then at the most recent follow-up after implantation of the second modality.
Spinal cord stimulation leads were percutaneous (n = 2) or paddles (n = 9) and commonly covered T8-10. IT medication included ziconotide (n = 8), baclofen (n = 1), hydromorphone (n = 1), and morphine/clonidine (n = 1). There was a mean of 19.64 ± 3.17 months between primary and secondary intervention. There was a significant improvement in pain severity from baseline to implantation of the second modality (P = 0.032) at a mean follow-up of 50.18 ± 11.83 months.
Dual modality therapy is a potential treatment option in patients who have lost efficacy with a single neuromodulation modality. Further study is required to identify potential responders and nonresponders.
一些患有慢性疼痛和植入脊髓刺激器或鞘内（IT）泵的患者未能获得显著的疼痛缓解。两种疗法联合使用的双模态治疗方法研究较少。本研究评估了该患者人群的综合结果，并主要使用 IT 型肉毒毒素报告结果。
我们回顾性分析了 11 例接受脊髓刺激和 IT 治疗的慢性疼痛患者。当主要治疗未能实现显著的疼痛缓解时，尝试并植入了第二种设备。疼痛严重程度（通过数字评分量表测量）通过从基线到第一次和第二次干预后的变化来评估。在一组患者（n=6）中，还评估了生活质量指标。在植入第一种模式后最接近 1 年随访日期的情况下分析了结果测量值，然后在植入第二种模式后的最近随访中进行了分析。
脊髓刺激导联为经皮（n=2）或极板（n=9），通常覆盖 T8-10。IT 药物包括型肉毒毒素（n=8）、巴氯芬（n=1）、氢吗啡酮（n=1）和吗啡/可乐定（n=1）。初次和二次干预之间的平均时间为 19.64±3.17 个月。在平均随访 50.18±11.83 个月时，第二次干预植入后疼痛严重程度从基线显著改善（P=0.032）。
在单一神经调节模式疗效丧失的患者中，双模态治疗可能是一种治疗选择。需要进一步研究以确定潜在的反应者和非反应者。
