Wu Qichao, Cui Xiang, Guan Leo C, Zhang Chi, Liu Jing, Ford Neil C, He Shaoqiu, Chen Xueming, Cao Xu, Zang Lei, Guan Yun
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, 21205, USA.
Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100149, China.
J Orthop Translat. 2023 Sep 30;42:147-159. doi: 10.1016/j.jot.2023.07.003. eCollection 2023 Sep.
UNLABELLED: Chronic pain after spine surgery (CPSS) is often characterized by intractable low back pain and/or radiating leg pain, and has been reported in 8-40% of patients that received lumbar spine surgery. We conducted a literature search of PubMed, MEDLINE/OVID with a focus on studies about the etiology and treatments of CPSS and low back pain. Our aim was to provide a narrative review that would help us better understand the pathogenesis and current treatment options for CPSS. This knowledge will aid in the development of optimal strategies for managing postoperative pain symptoms and potentially curing the underlying etiologies. Firstly, we reviewed recent advances in the mechanistic study of CPSS, illustrated both structural (e.g., fibrosis and scaring) and non-structural factors (e.g., inflammation, neuronal sensitization, glial activation, psychological factor) causing CPSS, and highlighted those having not been given sufficient attention as the etiology of CPSS. Secondly, we summarized clinical evidence and therapeutic perspectives of CPSS. We also presented new insights about the treatments and etiology of CPSS, in order to raise awareness of medical staff in the identification and management of this complex painful disease. Finally, we discussed potential new targets for clinical interventions of CPSS and future perspectives of mechanistic and translational research. CPSS patients often have a mixed etiology. By reviewing recent findings, the authors advocate that clinicians shall comprehensively evaluate each case to formulate a patient-specific and multi-modal pain treatment, and importantly, consider an early intraoperative intervention that may decrease the risk or even prevent the onset of CPSS. TRANSLATIONAL POTENTIAL STATEMENT: CPSS remains difficult to treat. This review broadens our understanding of clinical therapies and underlying mechanisms of CPSS, and provides new insights which will aid in the development of novel mechanism-based therapies for not only managing the established pain symptoms but also preventing the development of CPSS.
未标注：脊柱手术后慢性疼痛（CPSS）通常表现为难治性腰痛和/或放射性腿痛，据报道，在接受腰椎手术的患者中有8%-40%出现该症状。我们对PubMed、MEDLINE/OVID进行了文献检索，重点关注关于CPSS和腰痛的病因及治疗的研究。我们的目的是提供一篇叙述性综述，以帮助我们更好地理解CPSS的发病机制和当前的治疗选择。这些知识将有助于制定优化策略来管理术后疼痛症状，并有可能治愈潜在病因。首先，我们回顾了CPSS机制研究的最新进展，阐述了导致CPSS的结构因素（如纤维化和瘢痕形成）和非结构因素（如炎症、神经元致敏、神经胶质激活、心理因素），并强调了那些作为CPSS病因尚未得到充分关注的因素。其次，我们总结了CPSS的临床证据和治疗观点。我们还提出了关于CPSS治疗和病因的新见解，以提高医务人员对这一复杂疼痛疾病的识别和管理意识。最后，我们讨论了CPSS临床干预的潜在新靶点以及机制和转化研究的未来前景。CPSS患者的病因往往是混合性的。通过回顾近期研究结果，作者主张临床医生应全面评估每个病例，以制定针对患者的多模式疼痛治疗方案，重要的是，应考虑早期术中干预，这可能降低CPSS的风险甚至预防其发生。 转化潜力声明：CPSS仍然难以治疗。本综述拓宽了我们对CPSS临床治疗和潜在机制的理解，并提供了新的见解，这将有助于开发基于新机制的疗法，不仅可以管理已有的疼痛症状，还可以预防CPSS的发生。
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