Neurosurgery of KUH Neuro Center, Kuopio, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
Neuromodulation. 2021 Jan;24(1):102-111. doi: 10.1111/ner.13297. Epub 2020 Oct 19.
Spinal cord stimulation (SCS) is an effective treatment in failed back surgery syndrome (FBSS). We studied the effect of preimplantation opioid use on SCS outcome and the effect of SCS on opioid use during a two-year follow-up period.
The study cohort included 211 consecutive FBSS patients who underwent an SCS trial from January 1997 to March 2014. Participants were divided into groups, which were as follows: 1) SCS trial only (n = 47), 2) successful SCS (implanted and in use throughout the two-year follow-up period, n = 131), and 3) unsuccessful SCS (implanted but later explanted or revised due to inadequate pain relief, n = 29). Patients who underwent explantation for other reasons (n = 4) were excluded. Opioid purchase data from January 1995 to March 2016 were retrieved from national registries.
Higher preimplantation opioid doses associated with unsuccessful SCS (ROC: AUC = 0.66, p = 0.009), with 35 morphine milligram equivalents (MME)/day as the optimal cutoff value. All opioids were discontinued in 23% of patients with successful SCS, but in none of the patients with unsuccessful SCS (p = 0.004). Strong opioids were discontinued in 39% of patients with successful SCS, but in none of the patients with unsuccessful SCS (p = 0.04). Mean opioid dose escalated from 18 ± 4 MME/day to 36 ± 6 MME/day with successful SCS and from 22 ± 8 MME/day to 82 ± 21 MME/day with unsuccessful SCS (p < 0.001).
Higher preimplantation opioid doses were associated with SCS failure, suggesting the need for opioid tapering before implantation. With continuous SCS therapy and no explantation or revision due to inadequate pain relief, 39% of FBSS patients discontinued strong opioids, and 23% discontinued all opioids. This indicates that SCS should be considered before detrimental dose escalation.
脊髓刺激（SCS）是治疗失败性腰椎手术综合征（FBSS）的有效方法。我们研究了植入前使用阿片类药物对 SCS 结果的影响，以及 SCS 在两年随访期间对阿片类药物使用的影响。
研究队列包括 1997 年 1 月至 2014 年 3 月期间接受 SCS 试验的 211 例连续 FBSS 患者。参与者分为三组：1）SCS 试验仅组（n = 47），2）成功 SCS 组（植入并在两年随访期间全程使用，n = 131），3）不成功 SCS 组（植入但因疼痛缓解不足而后来取出或修改，n = 29）。因其他原因取出的患者（n = 4）被排除在外。从国家登记处检索了 1995 年 1 月至 2016 年 3 月的阿片类药物购买数据。
较高的植入前阿片类药物剂量与不成功的 SCS 相关（ROC：AUC = 0.66，p = 0.009），35 吗啡毫克当量（MME）/天为最佳截断值。所有阿片类药物在成功的 SCS 患者中有 23%被停用，但在不成功的 SCS 患者中没有被停用（p = 0.004）。在成功的 SCS 患者中有 39%的强阿片类药物被停用，但在不成功的 SCS 患者中没有被停用（p = 0.04）。成功 SCS 后，阿片类药物的平均剂量从 18±4 MME/天增加到 36±6 MME/天，而不成功 SCS 后从 22±8 MME/天增加到 82±21 MME/天（p<0.001）。
较高的植入前阿片类药物剂量与 SCS 失败相关，这表明在植入前需要进行阿片类药物减量。在持续的 SCS 治疗且没有因疼痛缓解不足而取出或修改的情况下，39%的 FBSS 患者停止使用强阿片类药物，23%的患者停止使用所有阿片类药物。这表明 SCS 应该在有害剂量增加之前考虑。
