1Faculty of Medicine, Ain Shams University, Cairo, Egypt.
2Department of Radiation Oncology, University of Kentucky, Lexington, Kentucky.
Neurosurg Focus. 2022 Oct;53(4):E13. doi: 10.3171/2022.7.FOCUS22330.
Neuropathic pain is undertreated in children. Neurosurgical treatments of pediatric chronic pain are limited by the absence of both US Food and Drug Administration approval and pediatric-specific hardware, as well as weak referral patterns due to a lack of physician education. This study presents a single-institution retrospective case series of spinal cord stimulation (SCS) in children ≤ 19 years of age and a systematic review of SCS in children. The authors' findings may further validate the role of SCS as an effective treatment modality for varied neuropathic pain syndromes found in pediatric patients.
The study was a single-center, single-surgeon, retrospective case series of individuals treated between July 2017 and May 2022. The outcomes for pediatric patients with chronic neuropathic pain syndromes indicated by the multidisciplinary pain clinic for evaluation for SCS were cataloged. A systematic review and individual participant data (IPD) meta-analysis was performed for cases treated until May 2022, using PubMed, EMBASE, and Scopus to characterize outcomes of children with neuropathic pain treated with SCS.
Twelve patients were evaluated and 9 were indicated for percutaneous or buried lead trials. Seven female and 2 male patients between the ages of 13 and 19 years were implanted with trial leads. Eight of 9 (89%) patients went on to receive permanent systems. The average trial length was 6 days, and the length of stay for both trial and implant was less than 1 day. Complication rates due to CSF leaks were 22% and 0% for trial and implant, respectively. Visual analog scale pain scores decreased from 9.2 to 2.9 (p = 0.0002) and the number of medications decreased from 4.9 to 2.1 (p = 0.0005). Functional status also improved for each patient. A systematic review identified 13 studies describing pediatric patients with SCS, including 12 providing IPD on 30 patients. In the IPD meta-analysis, pain was reduced in 16/16 (100%) of patients following surgery and in 25/26 (96.2%) at last follow-up. Medication use was decreased in 16/21 (76.2%), and functional outcomes were improved in 29/29 (100%). The complication rate was 5/30 (16.7%).
SCS effectively decreases pain and medication use for pediatric neuropathic pain syndromes. Patients also report improved functional status, including improved matriculation, gainful employment, and physical activity. There is minimal high-quality literature describing neuromodulation for pain in children. Neuromodulation should be considered earlier as a viable alternative to escalating use of multiple drugs and as a potential mechanism to address tolerance, dependence, and addiction in pediatric patients.
儿童的神经性疼痛治疗不足。儿科慢性疼痛的神经外科治疗受到缺乏美国食品和药物管理局 (FDA) 批准和儿科专用硬件的限制，以及由于医生教育不足导致转诊模式薄弱。本研究介绍了一项在≤19 岁儿童中进行脊髓刺激 (SCS) 的单机构回顾性病例系列研究，并对儿童 SCS 进行了系统评价。作者的发现可能进一步验证了 SCS 作为治疗儿科患者各种神经性疼痛综合征的有效治疗方法的作用。
该研究是一项单中心、单外科医生的回顾性病例系列研究，纳入了 2017 年 7 月至 2022 年 5 月期间接受治疗的个体。对多学科疼痛诊所评估 SCS 的慢性神经性疼痛综合征的儿科患者的结局进行了分类。对截至 2022 年 5 月接受治疗的病例进行了系统评价和个体参与者数据 (IPD) 荟萃分析，使用 PubMed、EMBASE 和 Scopus 对接受 SCS 治疗的神经性疼痛儿童的结局进行了描述。
共评估了 12 名患者，其中 9 名患者被指示进行经皮或埋藏导线试验。7 名 13 至 19 岁的女性和 2 名男性患者植入了试验导线。9 名患者中有 8 名 (89%)接受了永久性系统治疗。试验的平均长度为 6 天，试验和植入的住院时间均少于 1 天。由于脑脊液漏，试验和植入的并发症发生率分别为 22%和 0%。视觉模拟评分疼痛评分从 9.2 降至 2.9(p=0.0002)，药物使用量从 4.9 降至 2.1(p=0.0005)。每位患者的功能状态也有所改善。系统评价确定了 13 项描述儿科患者 SCS 的研究，其中 12 项提供了 30 名患者的 IPD。在 IPD 荟萃分析中，手术后疼痛得到缓解的患者有 16/16(100%)，最后一次随访时有缓解的患者有 25/26(96.2%)。药物使用减少的患者有 16/21(76.2%)，功能结局改善的患者有 29/29(100%)。并发症发生率为 5/30(16.7%)。
SCS 可有效减轻儿科神经性疼痛综合征的疼痛和药物使用。患者还报告说功能状态得到改善，包括改善入学、就业和体育活动。描述儿童疼痛神经调节的高质量文献很少。神经调节应更早被视为一种可行的替代方案，以替代多种药物的不断升级，并作为解决儿科患者耐受、依赖和成瘾的潜在机制。
