Spinal Cord Stimulation versus Repeated Lumbosacral Spine Surgery for Chronic Pain: A Randomized, Controlled Trial
Spinal Cord Stimulation versus Repeated Lumbosacral Spine Surgery for Chronic Pain: A Randomized, Controlled Trial
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脊髓刺激与重复腰骶脊柱手术治疗慢性疼痛：一项随机对照试验
DOI：
10.1227/01.neu.0000144839.65524.e0
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发表时间：
2005
期刊：
影响因子：
4.8
通讯作者：
S. Piantadosi
中科院分区：
文献类型：
--
作者：
R. North;D. Kidd;Farrokh R. Farrokhi;S. Piantadosi
目的：腰骶椎手术后持续性或复发性根性疼痛通常与神经根受压有关，可通过重复手术或作为最后手段的脊髓刺激（SCS）来治疗。我们进行了一项前瞻性、随机、对照试验，以检验我们的假设，即通过疼痛缓解和治疗结果（包括随后使用医疗保健资源）的标准衡量标准，SCS 比再次手术更有可能取得成功。方法：平均术后 3 年，公正的第三方访谈者对 50 名按照标准选择进行再次手术的患者进行了跟踪，并随机分为 SCS 或再次手术。如果随机治疗的结果不令人满意，患者可以转向替代治疗。成功取决于自我报告的疼痛缓解和患者满意度。交叉到替代程序是一种结果衡量标准。自我报告镇痛药的使用、日常生活活动和工作状态。结果：在 45 名可进行随访的患者（90%）中，SCS 比再次手术更成功（19 名患者中的 9 名与 26 名患者中的 3 名，P < 0.01）。最初随机接受 SCS 的患者发生交叉的可能性明显低于随机接受再次手术的患者（24 名患者中的 5 名与 26 名患者中的 14 名，P = 0.02）。随机接受再手术的患者比随机接受 SCS 的患者需要增加阿片类镇痛药的频率明显更高 (P < 0.025)。日常生活活动和工作状态的其他指标没有显着差异。结论：对于腰骶椎术后持续性神经根痛的治疗，SCS 比再次手术更有效，并且对于大多数患者来说，无需再次手术。
OBJECTIVE:Persistent or recurrent radicular pain after lumbosacral spine surgery is often associated with nerve root compression and is treated by repeated operation or, as a last resort, by spinal cord stimulation (SCS). We conducted a prospective, randomized, controlled trial to test our hypothesis that SCS is more likely than reoperation to result in a successful outcome by standard measures of pain relief and treatment outcome, including subsequent use of health care resources. METHODS:For an average of 3 years postoperatively, disinterested third-party interviewers followed 50 patients selected for reoperation by standard criteria and randomized to SCS or reoperation. If the results of the randomized treatment were unsatisfactory, patients could cross over to the alternative. Success was based on self-reported pain relief and patient satisfaction. Crossover to the alternative procedure was an outcome measure. Use of analgesics, activities of daily living, and work status were self-reported. RESULTS:Among 45 patients (90%) available for follow-up, SCS was more successful than reoperation (9 of 19 patients versus 3 of 26 patients, P < 0.01). Patients initially randomized to SCS were significantly less likely to cross over than were those randomized to reoperation (5 of 24 patients versus 14 of 26 patients, P = 0.02). Patients randomized to reoperation required increased opiate analgesics significantly more often than those randomized to SCS (P < 0.025). Other measures of activities of daily living and work status did not differ significantly. CONCLUSION:SCS is more effective than reoperation as a treatment for persistent radicular pain after lumbosacral spine surgery, and in the great majority of patients, it obviates the need for reoperation.