St. Luke's University Health Network, Bethlehem, PA.
Spine (Phila Pa 1976). 2021 Feb 1;46(3):E181-E186. doi: 10.1097/BRS.0000000000003752.
Retrospective chart review.
The aim of this study was to ascertain whether the presence of structural thoracic deformities affects outcomes of permanent SCS placement.
Neural modulation via spinal cord stimulators (SCSs) has become an accepted treatment option for various chronic pain syndromes. In most cases, the surgeon desires accurate midline positioning of the paddle lead, allowing for flexibility of unilateral or bilateral coverage of pain patterns. Structural spinal deformities (scoliosis or kyphosis) often result from coronal, sagittal, and rotatory deformity that can make midline placement more difficult.
Between 2013 and 2017, two-hundred forty-one charts of patients who underwent permanent SCS placement at our suburban hospital were reviewed. Demographic information, numerical rating system (NRS) pain scores, Oswestry Disability Index (ODI) scores, and opioid medication usage were recorded at baseline and after permanent stimulator placement. Thoracic scoliosis and kyphosis angles were measured using spinal radiographs. The effect of each structural deformity on NRS, ODI, and narcotic medication usage changes from baseline was analyzed.
Overall, 100 patients were included in our cohort. Fifty-six patients had measured thoracic spinal deformities (38% with scoliosis, 31% with kyphosis). There was no significant difference in NRS scores, ODI scores, or narcotic usage change between patients with scoliosis and those without (P = 0.66, P = 0.57, P = 0.75) or patients with kyphosis and those without (P = 0.51, P = 0.31, P = 0.63). Bivariate linear regression analysis showed that scoliotic and kyphotic angles were not significant predictors of NRS (P = 0.39, P = 0.13), ODI (P = 0.45, P = 0.07), and opioid usage (P = 0.70, P = 0.90) change, with multivariate regression analyses confirming these findings.
SCSs can be effective options for treating lumbar back pain and radiculopathy. Our study suggests that the presence of mild structural deformities does not adversely affect outcomes of permanent SCS placement and as such should not preclude this population from benefiting from such therapies.Level of Evidence: 4.
回顾性图表审查。
本研究旨在确定结构性胸脊柱畸形是否会影响永久性脊髓刺激器（SCS）放置的结果。
通过脊髓刺激器（SCS）进行神经调节已成为各种慢性疼痛综合征的一种公认的治疗选择。在大多数情况下，外科医生希望准确地将桨形导联置于中线位置，以便灵活地覆盖单侧或双侧疼痛模式。结构性脊柱畸形（脊柱侧凸或后凸）通常是由于冠状、矢状和旋转畸形导致的，这使得中线放置更加困难。
在 2013 年至 2017 年间，我们对在郊区医院接受永久性 SCS 放置的 241 例患者的图表进行了回顾。记录基线和永久性刺激器放置后的人口统计学信息、数字评分系统（NRS）疼痛评分、Oswestry 残疾指数（ODI）评分和阿片类药物使用情况。使用脊柱 X 线片测量胸脊柱侧凸和后凸角度。分析每个结构性畸形对 NRS、ODI 和阿片类药物使用变化的影响。
总体而言，我们的队列包括 100 名患者。56 名患者有测量的胸脊柱畸形（38%有脊柱侧凸，31%有后凸）。脊柱侧凸和无脊柱侧凸患者之间的 NRS 评分、ODI 评分或阿片类药物使用变化无显著差异（P=0.66，P=0.57，P=0.75）或后凸和无后凸患者之间（P=0.51，P=0.31，P=0.63）。双变量线性回归分析表明，脊柱侧凸和后凸角度不是 NRS（P=0.39，P=0.13）、ODI（P=0.45，P=0.07）和阿片类药物使用变化的显著预测因素，多变量回归分析证实了这些发现。
SCS 可以是治疗腰椎背痛和神经根病的有效选择。我们的研究表明，轻度结构性畸形的存在不会对永久性 SCS 放置的结果产生不利影响，因此不应阻止这些患者从这种治疗中受益。
4 级。
