Tieppo Francio Vinicius, Polston Keith F, Murphy Micheal T, Hagedorn Jonathan M, Sayed Dawood
Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, USA.
Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Biomedicines. 2021 Jun 4;9(6):644. doi: 10.3390/biomedicines9060644.
Since the inception of spinal cord stimulation (SCS) in 1967, the technology has evolved dramatically with important advancements in waveforms and frequencies. One such advancement is Nevro's Senza SCS System for HF10, which received Food and Drug and Administration (FDA) approval in 2015. Low-frequency SCS works by activating large-diameter Aβ fibers in the lateral discriminatory pathway (pain location, intensity, quality) at the dorsal column (DC), creating paresthesia-based stimulation at lower-frequencies (30-120 Hz), high-amplitude (3.5-8.5 mA), and longer-duration/pulse-width (100-500 μs). In contrast, high-frequency 10 kHz SCS works with a proposed different mechanism of action that is paresthesia-free with programming at a frequency of 10,000 Hz, low amplitude (1-5 mA), and short-duration/pulse-width (30 μS). This stimulation pattern selectively activates inhibitory interneurons in the dorsal horn (DH) at low stimulation intensities, which do not activate the dorsal column fibers. This ostensibly leads to suppression of hyperexcitable wide dynamic range neurons (WDR), which are sensitized and hyperactive in chronic pain states. It has also been reported to act on the medial pathway (drives attention and pain perception), in addition to the lateral pathways. Other theories include a reversible depolarization blockade, desynchronization of neural signals, membrane integration, glial-neuronal interaction, and induced temporal summation. The body of clinical evidence regarding 10 kHz SCS treatment for chronic back pain and neuropathic pain continues to grow. There is high-quality evidence supporting its use in patients with persistent back and radicular pain, particularly after spinal surgery. High-frequency 10 kHz SCS studies have demonstrated robust statistically and clinically significant superiority in pain control, compared to paresthesia-based SCS, supported by level I clinical evidence. Yet, as the field continues to grow with the technological advancements of multiple waveforms and programming stimulation algorithms, we encourage further research to focus on the ability to modulate pain with precision and efficacy, as the field of neuromodulation continues to adapt to the modern healthcare era.
自1967年脊髓刺激（SCS）技术问世以来，随着波形和频率方面的重要进展，该技术有了显著发展。其中一项进展是Nevro公司的用于HF10的Senza SCS系统，该系统于2015年获得美国食品药品监督管理局（FDA）批准。低频SCS的工作原理是激活背柱（DC）外侧辨别通路（疼痛位置、强度、性质）中的大直径Aβ纤维，以较低频率（30 - 120 Hz）、高幅度（3.5 - 8.5 mA）和较长持续时间/脉冲宽度（100 - 500 μs）产生基于感觉异常的刺激。相比之下，高频10 kHz SCS的作用机制有所不同，在10000 Hz频率、低幅度（1 - 5 mA）和短持续时间/脉冲宽度（30 μS）的编程下无感觉异常。这种刺激模式在低刺激强度下选择性激活背角（DH）中的抑制性中间神经元，而不激活背柱纤维。这表面上导致抑制在慢性疼痛状态下敏感且活跃的超兴奋性广动力范围神经元（WDR）。据报道，它除了作用于外侧通路外，还作用于内侧通路（驱动注意力和疼痛感知）。其他理论包括可逆性去极化阻滞、神经信号去同步化、膜整合、胶质-神经元相互作用以及诱导性时间总和。关于10 kHz SCS治疗慢性背痛和神经性疼痛的临床证据不断增加。有高质量证据支持其用于持续性背痛和神经根性疼痛患者，尤其是脊柱手术后的患者。高频10 kHz SCS研究表明，与基于感觉异常 的SCS相比，在疼痛控制方面具有统计学和临床意义上的显著优势，得到了I级临床证据的支持。然而，随着该领域随着多种波形和编程刺激算法的技术进步而不断发展，我们鼓励进一步研究，专注于精确且有效地调节疼痛的能力，因为神经调节领域继续适应现代医疗保健时代。
