Tekmyster Gene, Jonely Holly, Lee David W, Myerson Jason, Avery Melinda, Moradian Maxim, Desai Mehul J
Keck Medicine of USC, Orthopaedic Surgery, Los Angeles, CA, USA.
International Spine Pain & Performance Center, Washington, DC, USA.
Neuromodulation. 2023 Jan;26(1):260-269. doi: 10.1111/ner.13391. Epub 2022 Jun 14.
Spinal cord stimulation (SCS) is an established therapy option in interventional pain medicine. Recent advances in technology have allowed for greater compliance with treatment and improved efficacy in pain control. This article was proposed to fill the gap in the literature addressing this specific patient population and to facilitate further research. Even though there is a lack of consensus among societies and experts on exact parameters of physical therapy (PT) considerations and postoperative limitations in patients with SCS, we propose rehabilitative care for this population should be standardized. As the number of patients with SCS implants grow, it is vital to understand how to appropriately approach patients with implantable devices when additional treatments such as PT are prescribed.
A literature search was performed on the use of PT following SCS implantation. Presently, there is no literature to date which addresses the use of PT in this patient population. The lack of data is the largest hurdle in the creation of formal SCS therapy guidelines. The authors therefore proposed recommendations for rehabilitation based upon a detailed understanding of SCS hardware alongside well-studied physiotherapy concepts.
Considerations when initiating PT in the SCS patient population should include: 1) biomechanics and quality of SCS output; 2) therapeutic exercise and spinal manipulation in association with risk for lead migration and fracture; 3) the application of therapeutic modalities and risk for injury to the patient and/or damage to the SCS componentry; and 4) integration of a biopsychosocial, person-centered approach.
PT treatment protocol in patients with a recently implanted SCS device should be person-centered addressing individual needs, values, and goals. Further research is needed to fully appreciate the impact of an interprofessional approach to management of SCS patients, particularly following stimulator implantation.
脊髓刺激（SCS）是介入性疼痛医学中一种既定的治疗选择。技术的最新进展使得患者对治疗的依从性更高，疼痛控制效果也有所改善。本文旨在填补文献中针对这一特定患者群体的空白，并促进进一步的研究。尽管社会各界和专家对于脊髓刺激患者物理治疗（PT）的具体考量参数以及术后限制尚未达成共识，但我们建议应为这一群体的康复护理制定标准化方案。随着植入脊髓刺激装置的患者数量不断增加，当开具诸如物理治疗等额外治疗时，了解如何妥善处理植入可植入设备的患者至关重要。
对脊髓刺激植入术后物理治疗的使用情况进行了文献检索。目前，尚无文献涉及该患者群体的物理治疗应用。缺乏数据是制定正式脊髓刺激治疗指南的最大障碍。因此，作者基于对脊髓刺激硬件的详细了解以及经过充分研究的物理治疗概念，提出了康复建议。
在脊髓刺激患者群体中开始物理治疗时应考虑的因素包括：1）脊髓刺激输出的生物力学和质量；2）治疗性运动和脊柱手法治疗与电极移位和骨折风险的关系；3）治疗方式的应用以及对患者的损伤风险和/或对脊髓刺激组件的损坏；4）生物心理社会、以患者为中心的方法的整合。
近期植入脊髓刺激装置患者的物理治疗方案应以患者为中心，满足个体需求、价值观和目标。需要进一步研究以充分认识跨专业方法对脊髓刺激患者管理的影响，特别是在刺激器植入后。
