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脊髓刺激治疗脊髓损伤相关疼痛:一项初步研究。

Spinal Cord Stimulation for Spinal Cord Injury-Related Pain: A Pilot Study.

作者信息

Alamri Alexander, MacDonald Meredith, Al-Mohammad Alaa, Ricciardi Lucia, Hart Michael G, Pereira Erlick A

机构信息

Institute of Neurosciences and Cell Biology, City St. George's, University of London, London WC1E 7HU, UK.

Department of Neurosurgery, St. George's University Hospital, London SW17 0QT, UK.

出版信息

Brain Sci. 2024 Nov 22;14(12):1173. doi: 10.3390/brainsci14121173.

Abstract

BACKGROUND

Spinal cord stimulation (SCS) has emerged as an effective treatment for managing chronic pain that is unresponsive to traditional therapies. While SCS is well documented for conditions like failed back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS), its effectiveness in managing pain related to spinal cord injuries (SCI) is less studied. This study aims to assess the efficacy of SCS in alleviating SCI-related pain and improving patients' quality of life, filling a gap in the existing literature.

METHODS

This cohort study included 15 adult patients with traumatic and non-traumatic SCIs, treated between 2016 and 2022. Patients received SCS implants after either a trial or direct implantation. Pain levels were assessed using visual analog scale (VAS) scores, while quality of life was evaluated using the EuroQol five-dimensional (EQ-5D) scale. The SCS devices were implanted at different spinal levels, with various stimulation protocols applied, including high-frequency stimulation (10 kHz).

RESULTS

In patients with traumatic SCI, the mean VAS score decreased from 8.6 to 4.5, with 71% reporting more than 50% pain relief. Non-traumatic SCI patients experienced a reduction from 8.5 to 2.5, with all showing more than 50% pain relief. EQ-5D scores improved in both groups. A 49% reduction in pain medication usage was also observed, though one patient required revision surgery due to an adverse event.

CONCLUSIONS

SCS significantly reduces pain and improves quality of life for SCI patients, particularly with high-frequency protocols. While promising, further research is needed to optimize patient selection and stimulation parameters for better long-term outcomes.

摘要

背景

脊髓刺激(SCS)已成为治疗对传统疗法无反应的慢性疼痛的有效方法。虽然SCS在诸如失败的脊柱手术综合征(FBSS)和复杂性区域疼痛综合征(CRPS)等病症方面有充分记录,但其在治疗与脊髓损伤(SCI)相关疼痛方面的有效性研究较少。本研究旨在评估SCS在减轻SCI相关疼痛和改善患者生活质量方面的疗效,填补现有文献中的空白。

方法

这项队列研究纳入了15名2016年至2022年间接受治疗的成年创伤性和非创伤性SCI患者。患者在进行试验或直接植入后接受SCS植入。使用视觉模拟量表(VAS)评分评估疼痛程度,同时使用欧洲五维健康量表(EQ-5D)评估生活质量。SCS装置植入不同的脊柱节段,应用了各种刺激方案,包括高频刺激(10kHz)。

结果

创伤性SCI患者的平均VAS评分从8.6降至4.5,71%的患者报告疼痛缓解超过50%。非创伤性SCI患者的评分从8.5降至2.5,所有患者均显示疼痛缓解超过50%。两组的EQ-5D评分均有所改善。还观察到止痛药物使用量减少了49%,不过有一名患者因不良事件需要进行翻修手术。

结论

SCS能显著减轻SCI患者的疼痛并改善其生活质量,尤其是采用高频方案时。虽然前景乐观,但仍需要进一步研究以优化患者选择和刺激参数,从而获得更好的长期效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8643/11674956/cad9045c85f5/brainsci-14-01173-g001.jpg

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