The Evolving Role of High-Frequency Spinal Cord Stimulation as Salvage Therapy in Neurostimulation
The Evolving Role of High-Frequency Spinal Cord Stimulation as Salvage Therapy in Neurostimulation
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DOI：
10.1111/papr.12898
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发表时间：
2020-05-15
期刊：
影响因子：
2.6
通讯作者：
Simopoulos, Thomas
中科院分区：
文献类型：
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作者：
Ghosh, Priyanka E.;Gill, Jatinder S.;Simopoulos, Thomas
背景 高频 10 kHz 脊髓刺激 (10 kHz SCS) 在多中心前瞻性试验中显示出治疗慢性背部和腿部疼痛的前景。传统脊髓刺激（t-SCS）在治疗慢性神经病理性综合征方面有着悠久的有效性，但通常无法提供长期缓解，导致大量患者的治疗结果不令人满意。越来越多的证据表明 10-kHz SCS 可以缓解这部分患者的疼痛。 方法 本回顾性分析的目的是报告单一机构对先前 t-SCS 装置未获得充分疼痛缓解的患者进行 10-kHz SCS 的长期经验。对 10kHz SCS 进行了为期 7 天的临时试验，疼痛强度平均降低 50% 的患者接受了植入。如果缓解率为 31% 至 50%，则将患者归类为中度反应者；如果疼痛缓解超过 50%，则将患者归类为优秀反应者。 结果 主要因感觉异常覆盖率较差而导致 t-SCS 失败的 31 名患者接受了 10-kHz SCS 试验，其中 29 名患者接受了植入。 28 名患者可供分析，其中 57.1% 的患者在中位随访时间为 21.2 (+/- 8.4) 个月时获得了 30% 的缓解，46.4% 的患者获得了极好的缓解。 结论 这项小型单机构研究表明，很大一部分先前 t-SCS 失败的患者可以通过 10-kHz SCS 实现具有临床意义的持久疼痛缓解。
Background High-frequency 10-kHz spinal cord stimulation (10-kHz SCS) has shown promise in multicenter prospective trials for the management of chronic back and leg pain. Traditional spinal cord stimulation (t-SCS) has a long history of effectiveness in chronic neuropathic syndromes but not uncommonly can fail to provide long-term relief, leaving a significant group of patients with unsatisfactory outcomes. There is mounting evidence that 10-kHz SCS may offer relief in this subset of patients.Methods The purpose of this retrospective analysis was to report a single-institution long-term experience of 10-kHz SCS in patients who did not get adequate pain relief with prior t-SCS devices. A temporary trial of 10-kHz SCS was carried out for 7 days, and those experiencing an average of 50% reduction in pain intensity underwent implantation. Patients were classified as moderate responders if relief was 31% to 50% and excellent responders if pain relief exceeded 50%.Results Thirty-one patients who had experienced failed t-SCS primarily from poor paresthesia coverage underwent a trial of 10-kHz SCS and 29 underwent implantation. Twenty-eight patients were available for analysis, with 57.1% experiencing 30% response and 46.4% experiencing excellent response at a median follow-up of 21.2 (+/- 8.4) months.Conclusions This small single-institution study suggests that a significant proportion of patients with previously failed t-SCS may achieve clinically meaningful and durable pain relief with 10-kHz SCS.