Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA.
Department of Neurosurgery, Albany Medical Center, Albany, New York, USA.
Stereotact Funct Neurosurg. 2022;100(1):1-7. doi: 10.1159/000517426. Epub 2021 Jul 19.
Spinal cord stimulation (SCS) is an efficacious chronic pain treatment most commonly used in middle-aged patients. Results from previous studies that investigated SCS' effects in older patient populations have been equivocal. We examine whether SCS outcomes correlate with age.
We retrospectively examined prospectively collected outcomes from 189 patients who underwent SCS at Albany Medical Center between 2012 and 2020. The patients completed the Numerical Rating Scale (NRS), McGill Pain Questionnaire (MPQ), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), and Pain Catastrophizing Scale (PCS) preoperatively and 1 year postoperatively. The mean percent change in each outcome was determined and compared via a regression analysis to determine relationships between patient age and each respective outcome metrics. Demographics were compared between patients aged under 65 versus those aged 65 and older via χ2 tests.
All subjects demonstrated the expected improvement on NRS, BDI, PCS, and MPQ from baseline to 1-year follow-up, with several demonstrating statistically significant changes: NRS-worst pain (18.66%, p < 0.001), NRS-least pain (26.9%, p < 0.001), NRS-average pain (26.9%, p < 0.01), NRS-current pain (26.4%, p < 0.001), ODI (19.6%, p < 0.001), PCS (29.8%, p < 0.001), and MPQ (29.4%, p < 0.001). There was no significant difference between patients aged under 65 versus those aged 65 and older based on lead type (p = 0.454). Six patients (3.1%) had lead migration, one of whom was 65 or older. Regression analysis revealed improvements in MPQ-sensory and MPQ-affective scores as age increased (p < 0.001, R2 = 0.09; p = 0.046, R2 = 0.05, respectively). Age did not correlate with NRS, ODI, BDI, or PCS. Diagnosis, spinal level of SCS, and lead type were not found to influence any respective outcome measure based on covariate analysis.
This study represents the largest study where age was correlated to specific pain, depression, and disability outcomes following SCS. We provide evidence that SCS outcomes are equivalent, or better, in older patients following SCS. Based on these findings, SCS is a viable option for treatment of chronic pain in elderly patient populations.
脊髓刺激（SCS）是一种有效的慢性疼痛治疗方法，最常用于中年患者。之前研究 SCS 在老年患者群体中的效果的结果尚无定论。我们研究 SCS 结果是否与年龄相关。
我们回顾性分析了 2012 年至 2020 年间在奥尔巴尼医疗中心接受 SCS 的 189 名患者前瞻性收集的结果。患者在术前和术后 1 年完成数字评分量表（NRS）、麦吉尔疼痛问卷（MPQ）、Oswestry 残疾指数（ODI）、贝克抑郁量表（BDI）和疼痛灾难化量表（PCS）。通过回归分析确定每个结果的平均百分比变化，并比较患者年龄与每个特定结果指标之间的关系。通过卡方检验比较年龄在 65 岁以下和 65 岁及以上的患者之间的人口统计学差异。
所有患者在 NRS、BDI、PCS 和 MPQ 方面均表现出从基线到 1 年随访的预期改善，其中一些表现出统计学上的显著变化：NRS-最痛（18.66%，p < 0.001）、NRS-最轻痛（26.9%，p < 0.001）、NRS-平均痛（26.9%，p < 0.01）、NRS-当前痛（26.4%，p < 0.001）、ODI（19.6%，p < 0.001）、PCS（29.8%，p < 0.001）和 MPQ（29.4%，p < 0.001）。根据导联类型，年龄在 65 岁以下和 65 岁及以上的患者之间没有显著差异（p = 0.454）。有 6 名患者（3.1%）发生了导联移位，其中 1 名患者年龄在 65 岁或以上。回归分析显示，随着年龄的增长，MPQ-感觉和 MPQ-情感评分有所改善（p < 0.001，R2 = 0.09；p = 0.046，R2 = 0.05）。年龄与 NRS、ODI、BDI 或 PCS 不相关。根据协变量分析，诊断、SCS 的脊柱水平和导联类型未发现影响任何特定的结果测量。
本研究是最大的研究之一，其中年龄与 SCS 后特定的疼痛、抑郁和残疾结果相关。我们提供的证据表明，SCS 在老年患者中的效果与年轻患者相当，甚至更好。基于这些发现，SCS 是治疗老年患者慢性疼痛的可行选择。
