El Hadwe Salim, Wronowski Filip, Rehman Sara, Ansong Snr Yaw Ofosu, Barone Damiano G
Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; Department of Engineering, University of Cambridge, Cambridge, UK.
Department of Engineering, University of Cambridge, Cambridge, UK.
Neuromodulation. 2025 Feb;28(2):204-233. doi: 10.1016/j.neurom.2024.10.007. Epub 2024 Nov 26.
This systematic review compares the long-term efficacy of cylindrical-lead spinal cord stimulation (CL-SCS) vs paddle-lead spinal cord stimulation (Paddle-SCS) for chronic pain management.
We included prospective and retrospective studies with at least ten patients reporting on the efficacy of either lead type. Primary outcomes were pain score reduction (measured by the visual analog scale [VAS] and numeric rating scale [NRS]) and 50% pain relief after at least 12 months. Secondary outcomes included functional disability and complications, such as lead migration and infection rates. Meta-analyses compared effect sizes, while meta-regression and subgroup analyses addressed heterogeneity.
A total of 96 studies, comprising 7726 patients, met the inclusion criteria. Paddle-SCS demonstrated superior pain reduction, with a standardized mean difference (SMD) of 5.37 (95% CI [5.35, 5.38]) compared with CL-SCS, which had an SMD of 4.09 (95% CI [4.08, 4.10]) on the VAS. However, CL-SCS outperformed Paddle-SCS on the NRS, with SMDs of 4.39 vs 2.35, respectively. For 50% pain relief, Paddle-SCS had a success rate of 41.4%, as opposed to 35.4% for CL-SCS. Paddle-SCS showed a lower migration rate (4.3% vs 7.2% for CL-SCS) but higher infection rates (5.0% vs 3.3%).
Paddle-SCS offers superior pain reduction (as measured by the VAS) and a lower migration rate, but a higher infection risk compared with CL-SCS. CL-SCS showed better outcomes as measured by the NRS. The choice between Paddle-SCS and CL-SCS should be individualized according to patient-specific factors and treatment goals. Further research with rigorous study designs is needed to provide clearer comparisons between these interventions.
本系统评价比较了柱状电极脊髓刺激（CL-SCS）与板状电极脊髓刺激（Paddle-SCS）在慢性疼痛管理中的长期疗效。
我们纳入了前瞻性和回顾性研究，这些研究中至少有10名患者报告了两种电极类型的疗效。主要结局为疼痛评分降低（通过视觉模拟量表[VAS]和数字评分量表[NRS]测量）以及至少12个月后疼痛缓解50%。次要结局包括功能障碍和并发症，如电极移位和感染率。荟萃分析比较效应大小，而荟萃回归和亚组分析探讨异质性。
共有96项研究（包括7726例患者）符合纳入标准。在VAS上，Paddle-SCS显示出更好的疼痛缓解效果，标准化平均差（SMD）为5.37（95%CI[5.35,5.38]），而CL-SCS的SMD为4.09（95%CI[4.08,4.10]）。然而，在NRS上，CL-SCS的表现优于Paddle-SCS，SMD分别为4.39和2.35。对于疼痛缓解50%，Paddle-SCS的成功率为41.4%，而CL-SCS为35.4%。Paddle-SCS的电极移位率较低（4.3%，而CL-SCS为7.2%），但感染率较高（5.0%，而CL-SCS为3.3%）。
与CL-SCS相比，Paddle-SCS在疼痛缓解方面更优（通过VAS测量）且电极移位率更低，但感染风险更高。以NRS衡量，CL-SCS显示出更好的效果。应根据患者的具体因素和治疗目标对Paddle-SCS和CL-SCS进行个体化选择。需要进一步开展设计严谨的研究，以对这些干预措施进行更清晰的比较。
