Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany.
Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany.
Neuromodulation. 2021 Apr;24(3):540-545. doi: 10.1111/ner.13278. Epub 2020 Sep 14.
We aimed to investigate the efficacy of new subperception stimulation paradigms including 1.2 kHz-high-frequency stimulation (HFS) and advanced-HFS field-shaping algorithm (dorsal horn HFS [DHHFS]) in refractory cases which initially benefited from conventional spinal cord stimulation (SCS) and lost the effect throughout time.
In the context of a rescue-therapy, patients underwent externalization of the implanted SCS-leads and were tested with multiple combinations of new SCS paradigms. Pain intensity was analyzed using the numeric rating scale (NRS), and data were collected preoperatively and at multiple postoperative follow-ups.
Thirty-seven patients underwent externalization of the leads. Mean preoperative NRS-score was 8.1/10 points (SD ± 0.9) for the ON-stimulation period. Patients received a combination of either tonic, burst and 1.2 kHz-HFS, or burst and 1.2 kHz-HFS, DHHFS, or 1.2 kHz-HFS and DHHFS, or 1.2 kHz-HFS alone. The mean postoperative NRS-score after the testing-phase was 3.8/10 points (SD ± 2.5), showing a 48.0% mean reduction (p < 0.001). In total, 29 patients reported a significant reduction above 50% in NRS-scores and therefore were reimplanted with new generators that could deliver the new paradigms. Eight patients underwent full SCS-system explantation. The patients who continued with the new paradigms (n = 29) reported mean NRS-scores of 3.5/10 points (SD ± 1.7) 12 months postoperatively, still showing a significant reduction of 43.3% when compared to preoperative scores (p < 0.001).
Rescue-therapy with combination of multiple waveforms, including tonic, burst, 1.2 kHz-HFS, and DHHFS, was associated with a significant pain relief in patients with failed conventional SCS. This approach is a safe and efficient and should be considered before explantation of the SCS-system.
我们旨在研究新的亚感知刺激范式的疗效，包括 1.2kHz 高频刺激（HFS）和先进的背角 HFS 场成型算法（DHHFS），这些范式适用于最初从常规脊髓刺激（SCS）中受益但随着时间的推移效果逐渐消失的难治性病例。
在挽救性治疗的背景下，患者接受了植入 SCS 引线的外置化，并通过多种新 SCS 范式的组合进行了测试。使用数字评分量表（NRS）分析疼痛强度，并在术前和多个术后随访中收集数据。
37 名患者接受了引线的外置化。ON 刺激期的平均术前 NRS 评分是 8.1/10 分（SD±0.9）。患者接受了以下组合中的一种：连续刺激、爆发刺激和 1.2kHz-HFS、爆发刺激和 1.2kHz-HFS、DHHFS、或 1.2kHz-HFS 和 DHHFS、或单独的 1.2kHz-HFS。测试阶段后的平均术后 NRS 评分是 3.8/10 分（SD±2.5），表明平均降低了 48.0%（p<0.001）。总共有 29 名患者报告 NRS 评分显著降低超过 50%，因此他们被重新植入了可以提供新范式的新发生器。8 名患者进行了完整的 SCS 系统取出。继续使用新范式的患者（n=29）在术后 12 个月报告的平均 NRS 评分为 3.5/10 分（SD±1.7），与术前评分相比仍显著降低了 43.3%（p<0.001）。
使用包括连续刺激、爆发刺激、1.2kHz-HFS 和 DHHFS 等多种波形的组合进行挽救性治疗，与失败的常规 SCS 患者的显著疼痛缓解相关。在考虑取出 SCS 系统之前，这种方法是安全有效的。
