Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Neuromodulation. 2022 Jul;25(5):657-670. doi: 10.1016/j.neurom.2021.11.013. Epub 2022 Feb 10.
Spinal cord stimulation (SCS) is an established therapy of failed back surgery syndrome (FBSS), although the effects on daily functioning, quality of life (QoL), and patients' expectations, experiences, and satisfaction remain elusive. The current integrative review aimed to summarize the overall effects of SCS in patients with FBSS on pain relief, health-related QoL, and daily activities.
PubMed, CINAHL, Embase, ClinicalTrials.gov, gray literature, and reference lists of relevant articles were searched for additional papers. All included studies were assessed for risk of bias using the Mixed Methods Appraisal Tool. Following the methods of Whittemore and Knafl, an integrative review and a meta-analysis were performed.
In total, 16 articles were included; 11 articles presented quantitative outcomes, and five articles presented qualitative data. Lower back pain, leg pain, overall pain, Oswestry Disability Index, EuroQol Five Dimensions Health Questionnaire three-level/five-level, and the physical component score of Short Form Health Survey (SF-36) significantly improved during all follow-up moments. Only the mental component score of the SF-36 did not significantly improve, compared with baseline. Heterogeneity was diversely present among the studies. Patients' expectations and goals were disparate, although patients seemed to desire a return to their pre-FBSS state. Experiences with regard to the outcomes showed that patients largely recuperated after SCS, although limitations were still present. Patients also expressed inconvenience with regard to the trial period, implantation location, and recharging of the implantable pulse generator.
SCS showed beneficial effects on different domains of life in patients with FBSS. The quantitative analyses suggest an overall improvement in most domains, although patients' experiences show that limitations in daily life and living with the SCS system persist. Multiple extensive preoperative counseling sessions and discussions with patients are deemed necessary to improve patient satisfaction and meet their expectations. Shared decision-making and provision of complete information are key factors for success.
脊髓刺激（SCS）是治疗失败的腰椎手术综合征（FBSS）的一种既定疗法，尽管其对日常功能、生活质量（QoL）以及患者的期望、体验和满意度的影响仍难以捉摸。本次综合评价旨在总结 SCS 对 FBSS 患者的总体疗效，包括疼痛缓解、健康相关 QoL 和日常活动。
通过 PubMed、CINAHL、Embase、ClinicalTrials.gov、灰色文献和相关文章的参考文献列表搜索额外的论文。使用混合方法评估工具评估所有纳入研究的偏倚风险。按照 Whittemore 和 Knafl 的方法，进行综合评价和荟萃分析。
共纳入 16 篇文章，其中 11 篇文章呈现定量结果，5 篇文章呈现定性数据。所有随访时间点均显示下腰痛、腿痛、总疼痛、Oswestry 残疾指数、欧洲五维健康量表 3 级/5 级和简明健康调查量表（SF-36）的身体成分评分显著改善。与基线相比，仅 SF-36 的心理成分评分无显著改善。各研究间存在多样性异质性。尽管患者似乎希望回到 FBSS 前的状态，但患者的期望和目标存在差异。对于结局的体验表明，尽管仍存在限制，但患者在 SCS 后大多恢复。患者还表示对试验期、植入位置和可植入脉冲发生器的充电不便。
SCS 对 FBSS 患者的生活多个领域均有有益影响。定量分析表明，大多数领域均有整体改善，尽管患者的体验表明日常生活和 SCS 系统的限制仍然存在。需要进行多次广泛的术前咨询和与患者的讨论，以提高患者满意度并满足其期望。共同决策和提供完整信息是成功的关键因素。
