Department of Clinical Science, Umeå University, Umeå, Sweden.
Department of Clinical Science, Umeå University, Umeå, Sweden.
Neuromodulation. 2024 Jan;27(1):141-150. doi: 10.1016/j.neurom.2023.06.008. Epub 2023 Aug 4.
Chronic low back pain (CLBP) is one of the most common chronic pain conditions that cause both individual suffering and a burden to society. For these patients, several interventional treatment options such as surgery, blocks, radiofrequency, and spinal cord stimulation are available. Lately, dorsal root ganglion stimulation (DRG-S) also has been mentioned as an option by targeting bilateral T12 dorsal ganglia. In this study, we present the outcome of 11 patients with CLBP treated with bilateral T12 DRG-S.
Thirteen patients with CLBP with and without leg pain were treated with bilateral T12 DRG-S. Three of the patients also received a third lumbar lead owing to leg pain. Eleven of the patients had >50% pain relief during the peri- or/and postoperative testing and received a fully implantable neurostimulator. Pain intensity, general health status, quality of life, pain catastrophizing, mental status, sleeping disorder, physical activity, and patient satisfaction were followed using numeric rating scale (NRS), Patient-Reported Outcomes Measurement Information System 29 version 2.1, Pain Catastrophizing Score, Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire Depression Module, Insomnia Severity Index, and Patient Satisfaction Questionnaire at baseline before implantation and at three months and six months. The results were analyzed on the basis of six domains: pain relief, sleeping disorder, social ability, mental status, physical activity, and satisfaction. To be identified as a responder, the patients should show a significant improvement in the pain relief domain together with at least two other domains. All responders also were given the opportunity to test 4-Hz DRG-S and compare it with traditional 20-Hz stimulation.
All 11 patients were identified as responders at six months. Five of the patients had >80% pain relief, with an average NRS score reduction of 71% for the whole group. Significant improvement could be observed in three domains for one patient, four domains for three patients, five domains for six patients, and six domains for one patient. Seven patients chose to try 4-Hz stimulation. All seven identified 4-Hz stimulation as at least as good as or better than 20-Hz stimulation and chose to continue with 4-Hz stimulation.
Bilateral T12 DRG-S seems to be an effective treatment for chronic low back pain, with significant beneficial effect not only on pain but also on quality of life, pain catastrophizing, mental status, sleeping disorder, and physical activity. 4-Hz DRG-S gave a result comparable with or better than 20-Hz stimulation.
慢性下腰痛（CLBP）是最常见的慢性疼痛病症之一，会给患者个人带来痛苦，并给社会带来负担。对于这些患者，有几种介入治疗选择，如手术、阻滞、射频和脊髓刺激。最近，背根神经节刺激（DRG-S）也被提到作为一种选择，通过靶向双侧 T12 背根神经节。在这项研究中，我们报告了 11 例 CLBP 患者接受双侧 T12 DRG-S 治疗的结果。其中 3 例患者因腿部疼痛还接受了第三腰椎导联。11 例患者在围手术期测试中获得了 >50%的疼痛缓解，并接受了完全可植入的神经刺激器。使用数字评分量表（NRS）、患者报告的结果测量信息系统 29 版本 2.1、疼痛灾难化量表、广泛性焦虑症 7 项量表、患者健康问卷抑郁模块、失眠严重程度指数和患者满意度问卷，在植入前和植入后 3 个月和 6 个月时，对疼痛强度、一般健康状况、生活质量、疼痛灾难化、精神状态、睡眠障碍、身体活动和患者满意度进行了随访。结果基于六个领域进行分析：疼痛缓解、睡眠障碍、社会能力、精神状态、身体活动和满意度。为了被认定为应答者，患者应在疼痛缓解领域显示出显著改善，同时至少在其他两个领域也显示出改善。所有应答者也有机会测试 4-Hz DRG-S，并将其与传统的 20-Hz 刺激进行比较。
所有 11 例患者在 6 个月时均被认定为应答者。5 例患者疼痛缓解 >80%，整个组的平均 NRS 评分降低 71%。1 例患者的三个领域有显著改善，3 例患者的四个领域有显著改善，6 例患者的五个领域有显著改善，1 例患者的六个领域有显著改善。7 例患者选择尝试 4-Hz 刺激。所有 7 例患者均认为 4-Hz 刺激至少与 20-Hz 刺激一样好，或者更好，并选择继续使用 4-Hz 刺激。
双侧 T12 DRG-S 似乎是治疗慢性下腰痛的一种有效方法，不仅对疼痛而且对生活质量、疼痛灾难化、精神状态、睡眠障碍和身体活动都有显著的有益影响。4-Hz DRG-S 的结果与 20-Hz 刺激相当或更好。
