背景:在成人脊柱侧凸中,背侧器械和融合可以显着改善疼痛和残疾评分(OwestryIndex);但是,据报道,并发症发生率高达39%.因此,最近的尝试已经在扩大手术范围,包括患者的侵入性较小的技术,如神经调节,特别是脊髓刺激(SCS)。因此,我们旨在以初步研究的形式评估其在更大的成人脊柱侧凸患者队列中的使用。
方法:我们分析了2019年2月至2020年5月在我们机构接受SCS治疗的18名成年脊柱侧凸患者的前瞻性数据。在植入硬膜外SCS系统后3、6和12个月进行临床随访。患者报告了静息和运动时下腰痛(LBP)和区域性疼痛(RP)类别的数字评定量表(NRS)值。Further,SF-36,ADS-K,PSQI,ODI表格已经完成。该研究由机构伦理委员会(EA2/093/13)批准。
结果:静息时LBP的初始术前NRS在3时SCS后显着降低(降低45%,p=0.005)和6(减少43%,p=0.009)个月随访。运动中的LBP也降低了3(降低了27%,p=0.002)和6(减少33%与术前,p=0.005)个月。休息时的RP在3时减少(减少38%,p=0.003)和6(减少37%,p=0.007)和在3点运动(减少29%,0.006)和6(减少32%,p=0.011)。在6个月的随访中,胸椎后凸的消失和骨盆发生率的增加与NRS对SCS刺激的反应较差有关。
结论:超重,必须仔细考虑矫正手术的风险的老年人,神经调节可显著降低LBP和植入后6个月的局部疼痛.这些发现可能为不愿意或不符合接受广泛矫正手术的患者提供合理的替代方案。
BACKGROUND: In adult scoliosis, dorsal instrumentation and fusion can provide significant improvement of pain and disability scores (Owestry Index); however, complication rates of up to 39% have been reported. As such, recent attempts have been made at expanding the surgical spectrum to include less invasive techniques in patients such as neuromodulation, specifically spinal cord stimulation (
SCS). We therefore aimed to evaluate its use in a larger cohort of adult scoliosis patients in the form of a pilot
study.
METHODS: We analyzed prospectively collected data from 18 adult scoliosis patients receiving
SCS treatment in our institution between February 2019 and May 2020. Clinical follow-up was performed at 3, 6, and 12 months following implantation of an epidural SCS System. Patients reported numeric rating scale (NRS) values for the categories of lower back pain (LBP) and regional pain (RP) both at rest and in motion. Further, SF-36, ADS-K, PSQI, and ODI forms were completed. The
study was approved by the institutional Ethics Committee (EA2/093/13).
RESULTS: Initial preoperative NRS of LBP at rest was significantly reduced following
SCS at three (45% reduction, p = 0.005) and six (43% reduction, p = 0.009) months follow-up. LBP in motion was also reduced at three (27% reduction, p = 0.002) and six (33% reduction vs. preoperative, p = 0.005) months. RP at rest was reduced at three (38% reduction, p = 0.003) and six (37% reduction, p = 0.007) and in movement at three (29% reduction, 0.006) and six (32% reduction, p = 0.011). Loss of thoracic kyphosis and increased pelvic incidence were associated with worse NRS response to SCS stimulation at six months follow-up.
CONCLUSIONS: In overweight, older adults for whom the risks of corrective surgery must be carefully considered, neuromodulation can significantly reduce LBP as well as regional pain in the first six months following implantation. These findings may provide a reasonable alternative in patients not willing or eligible to undergo extensive corrective surgery.