Guys & St. Thomas NHS Foundation Trust, London, UK.
Neuromodulation. 2021 Apr;24(3):488-498. doi: 10.1111/ner.13219. Epub 2020 Aug 7.
Ten kilohertz spinal cord stimulation (SCS) is usually initiated in a single-bipolar configuration over the radiological reference point T9/T10 intervertebral disc space for neuropathic back and leg pain. Cascade is a duty-cycled, multi-bipolar contact configuration across an entire eight-contact lead. Potential advantages by using a broader area of SCS coverage include mitigation against minor lead migration and a reduction in the need for reprogramming. We report here the results of a retrospective case series of 114 patients using Cascade.
Retrospective data were collected over two years. We selected patients with neuropathic back with or without/leg pain who had a trial of SCS. Pain assessments using Numerical Rating Scales (NRS) and Patient Global Impression of Change (PGIC) scores were collected at baseline, six months, and last follow-up beyond 12 months (mean 15.1 months). Patients were programmed with 10 kHz SCS using Cascade during the trial, which was continued unless reporting inadequate pain relief. Morbidity and deviations from Cascade programming were also obtained.
At six months, 87 of 97 (90.6%) patients with active devices were using Cascade and 58 of 72 (81%) patients at the last follow-up >12 months. There was a significant reduction in back NRS (8.3 vs. 3.9 [p < 0.0001], N = 97) and leg pain (7.53 vs. 3.83 [p < 0.0001], N = 77) at 6 months and last follow-up >12 months back (8.3 vs. 3.95 [p < 0.0001] N = 72), leg (7.53 vs. 3.534 [p < 0.0001], N = 58). The PGIC score was 6 of 7 or all of 7 in 72% of patients (70/97) at six months and in 68% (49/72) of patients at the last follow-up beyond 12 months.
Cascade is an effective programming methodology that may have benefits over a single-bipole configuration for 10 kHz SCS, particularly during a trial of stimulation. Results from this study suggest it is a durable program for patients with neuropathic back and leg pain.
10kHz 脊髓刺激（SCS）通常在 T9/T10 椎间盘中沿放射学参考点以单双极配置开始，用于治疗神经性腰背和下肢疼痛。Cascade 是一种具有周期性的多双极接触配置，可横跨整个 8 触点引线。使用更广泛的 SCS 覆盖区域的潜在优势包括减轻轻微引线迁移的影响和减少重新编程的需要。我们在此报告使用 Cascade 的 114 例患者的回顾性病例系列结果。
在两年期间收集了回顾性数据。我们选择了有神经性腰背疼痛或伴或不伴下肢疼痛的患者，这些患者接受了 SCS 试验。使用数字评分量表（NRS）和患者总体印象变化（PGIC）评分在基线、6 个月和 12 个月以上的最后随访时收集疼痛评估数据（平均 15.1 个月）。在试验过程中，使用 10kHz SCS 对患者进行 Cascade 编程，如果报告疼痛缓解不足，则继续使用。还获得了发病率和偏离 Cascade 编程的情况。
在 6 个月时，97 例有活动设备的患者中有 87 例（90.6%）正在使用 Cascade，在 12 个月以上的最后随访中，72 例中有 58 例（81%）正在使用。6 个月和 12 个月以上的随访时，腰背 NRS（8.3 与 3.9 [p<0.0001]，N=97）和下肢疼痛（7.53 与 3.83 [p<0.0001]，N=77）均显著降低，腰背（8.3 与 3.95 [p<0.0001]，N=72），下肢（7.53 与 3.534 [p<0.0001]，N=58）。在 6 个月时，72%的患者（70/97）和 12 个月以上的最后随访中，68%的患者（49/72）的 PGIC 评分均为 7 分中的 6 分或 7 分。
Cascade 是一种有效的编程方法，与 10kHz SCS 的单双极配置相比，它可能具有优势，特别是在刺激试验期间。这项研究的结果表明，它是一种治疗神经性腰背和下肢疼痛的耐用方案。
