Rigoard Philippe, Ounajim Amine, Goudman Lisa, Banor Tania, Héroux France, Roulaud Manuel, Babin Etienne, Bouche Bénédicte, Page Philippe, Lorgeoux Bertille, Baron Sandrine, Adjali Nihel, Nivole Kevin, Many Mathilde, Charrier Elodie, Rannou Delphine, Poupin Laure, Wood Chantal, David Romain, Moens Maarten, Billot Maxime
PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France.
Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 86021 Poitiers, France.
J Clin Med. 2022 Jan 5;11(1):272. doi: 10.3390/jcm11010272.
While paresthesia-based Spinal Cord Stimulation (SCS) has been proven effective as treatment for chronic neuropathic pain, its initial benefits may lead to the development of "Failed SCS Syndrome' (FSCSS) defined as decrease over time related to Loss of Efficacy (LoE) with or without Loss of Coverage (LoC). Development of technologies associating new paresthesia-free stimulation waveforms and implanted pulse generator adapters provide opportunities to manage patients with LoE. The main goal of our study was to investigate salvage procedures, through neurostimulation adapters, in patients already implanted with SCS and experiencing LoE. We retrospectively analyzed a cohort of patients who were offered new SCS programs/waveforms through an implanted adapter between 2018 and 2021. Patients were evaluated before and at 1-, 3-, 6- and 12-month follow-ups. Outcomes included pain intensity rating with a Visual Analog Scale (VAS), pain/coverage mappings and stimulation preferences. Last follow-up evaluations (N = 27) showed significant improvement in VAS ( = 0.0001), ODI ( = 0.021) and quality of life ( = 0.023). In the 11/27 patients with LoC, SCS efficacy on pain intensity (36.89%) was accompanied via paresthesia coverage recovery (55.57%) and pain surface decrease (47.01%). At 12-month follow-up, 81.3% preferred to keep tonic stimulation in their waveform portfolio. SCS conversion using adapters appears promising as a salvage solution, with an emphasis on paresthesia recapturing enabled via spatial retargeting. In light of these results, adapters could be integrated in SCS rescue algorithms or should be considered in SCS rescue.
虽然基于感觉异常的脊髓刺激（SCS）已被证明是治疗慢性神经性疼痛的有效方法，但其最初的益处可能会导致“脊髓刺激失败综合征”（FSCSS）的发生，该综合征定义为随着时间的推移，与疗效丧失（LoE）相关的疗效下降，无论是否伴有覆盖范围丧失（LoC）。将新的无感觉异常刺激波形与植入式脉冲发生器适配器相结合的技术发展为管理出现疗效丧失的患者提供了机会。我们研究的主要目标是通过神经刺激适配器，对已植入SCS并出现疗效丧失的患者进行挽救性治疗。我们回顾性分析了一组在2018年至2021年间通过植入式适配器接受新SCS程序/波形治疗的患者。在患者植入前以及随访1个月、3个月、6个月和12个月时进行评估。结果包括使用视觉模拟量表（VAS）进行的疼痛强度评分、疼痛/覆盖范围映射以及刺激偏好。最后一次随访评估（N = 27）显示，VAS（P = 0.0001）、Oswestry功能障碍指数（ODI，P = 0.021）和生活质量（P = 0.023）均有显著改善。在11/27例出现覆盖范围丧失的患者中，SCS对疼痛强度的疗效（36.89%）伴随着感觉异常覆盖范围的恢复（55.57%）和疼痛面积的减小（47.01%）。在12个月的随访中，81.3%的患者更倾向于在其波形组合中保留强直刺激。使用适配器进行SCS转换作为一种挽救性解决方案似乎很有前景，重点是通过空间重新定位实现感觉异常的重新捕捉。鉴于这些结果，适配器可整合到SCS挽救算法中，或应在SCS挽救中予以考虑。
