PDF(Pubmed)
Abstract：
While paresthesia-based Spinal Cord Stimulation (SCS) has been proven effective as treatment for chronic neuropathic pain, its initial benefits may lead to the development of \"Failed SCS Syndrome\' (FSCSS) defined as decrease over time related to Loss of Efficacy (LoE) with or without Loss of Coverage (LoC). Development of technologies associating new paresthesia-free stimulation waveforms and implanted pulse generator adapters provide opportunities to manage patients with LoE. The main goal of our study was to investigate salvage procedures, through neurostimulation adapters, in patients already implanted with SCS and experiencing LoE. We retrospectively analyzed a cohort of patients who were offered new SCS programs/waveforms through an implanted adapter between 2018 and 2021. Patients were evaluated before and at 1-, 3-, 6- and 12-month follow-ups. Outcomes included pain intensity rating with a Visual Analog Scale (VAS), pain/coverage mappings and stimulation preferences. Last follow-up evaluations (N = 27) showed significant improvement in VAS (p = 0.0001), ODI (p = 0.021) and quality of life (p = 0.023). In the 11/27 patients with LoC, SCS efficacy on pain intensity (36.89%) was accompanied via paresthesia coverage recovery (55.57%) and pain surface decrease (47.01%). At 12-month follow-up, 81.3% preferred to keep tonic stimulation in their waveform portfolio. SCS conversion using adapters appears promising as a salvage solution, with an emphasis on paresthesia recapturing enabled via spatial retargeting. In light of these results, adapters could be integrated in SCS rescue algorithms or should be considered in SCS rescue.
摘要：
虽然基于感觉异常的脊髓刺激（SCS）已被证明可有效治疗慢性神经性疼痛，其最初的益处可能导致“失败的SCS综合征”(FSCSS)的发展,其定义为随着时间的推移与有或没有承保损失(LoC)的疗效损失(LoE)相关的减少。新的无感觉异常刺激波形和植入式脉冲发生器适配器相关技术的开发提供了管理LoE患者的机会。我们研究的主要目的是调查救助程序，通过神经刺激适配器，已经植入SCS并经历LoE的患者。我们回顾性分析了一组患者，这些患者在2018年至2021年之间通过植入适配器提供了新的SCS程序/波形。患者在1之前和之前进行评估，3-,6个月和12个月的随访。结果包括视觉模拟量表（VAS）的疼痛强度等级，疼痛/覆盖范围映射和刺激偏好。最后一次随访评估（N=27）显示VAS显着改善（p=0.0001），ODI(p=0.021)和生活质量(p=0.023)。在11/27的LoC患者中，SCS对疼痛强度的疗效（36.89％）伴随着感觉异常覆盖率恢复（55.57％）和疼痛表面减少（47.01％）。在12个月的随访中，81.3%的人更愿意在波形组合中保留强直刺激。使用适配器进行SCS转换似乎很有希望成为一种挽救解决方案，强调通过空间重新定位实现的感觉异常重获。鉴于这些结果,适配器可以集成在SCS救援算法中，或者应该在SCS救援中考虑。
