Department of Spine Surgery, Leopoldina-Krankenhaus der Stadt Schweinfurt, Schweinfurt, Germany.
Neurologia (Engl Ed). 2022 Sep;37(7):586-595. doi: 10.1016/j.nrleng.2019.05.007. Epub 2021 May 25.
The gate control theory of pain was the starting point of the development of spinal cord stimulation (SCS). We describe the indications for the treatment in pain management and other uses not related to pain.
There are currently several paradigms for SCS: tonic, burst, and high frequency. The main difference lies in the presence of paraesthesias. SCS is most beneficial for treating neuropathic pain. Patients with failed back surgery syndrome show the best response rates, although a considerable reduction in pain is also observed in patients with complex regional pain syndrome, diabetic neuropathy, radiculopathy, and low back pain without previous surgery. Phantom pain or pain related to cardiovascular or peripheral vascular disease may improve, although there is a lack of robust evidence supporting generalisation of its use. SCS also improves cancer-related pain, although research on this issue is scarce. Non-pain-related indications for SCS are movement disorders, spasticity, and sequelae of spinal cord injury. The main limiting factors for the use of SCS are mechanical complications and the cost of the treatment.
In its 50-year history, SCS has progressed enormously. The perfection of hardware and software may improve its effectiveness and reduce the rate of complications. Indications for SCS could include other diseases, and its use could be expanded, if the costs of the technology are reduced.
疼痛的闸门控制理论是脊髓刺激（SCS）发展的起点。我们描述了 SCS 在疼痛管理和其他非疼痛相关用途中的治疗适应症。
目前有几种 SCS 模式：持续刺激、爆发刺激和高频刺激。主要区别在于是否存在感觉异常。SCS 对治疗神经性疼痛最有效。后路手术失败综合征患者的反应率最高，尽管复杂区域疼痛综合征、糖尿病性神经病、神经根病和无先前手术的腰痛患者的疼痛也有明显减轻。幻肢痛或与心血管或外周血管疾病相关的疼痛可能会改善，尽管缺乏支持其广泛应用的有力证据。SCS 还可以改善癌症相关疼痛，尽管这方面的研究很少。SCS 的非疼痛相关适应症是运动障碍、痉挛和脊髓损伤后遗症。SCS 使用的主要限制因素是机械并发症和治疗费用。
在其 50 年的历史中，SCS 取得了巨大的进展。硬件和软件的完善可能会提高其疗效并降低并发症的发生率。如果技术成本降低，SCS 的适应症可能包括其他疾病，并且可以扩大其使用范围。
