Spinal Cord Stimulation for the Treatment of Chronic Pain – The Initial Osijek Experience

Abstract

Stimulacija kralježnične moždine (engl. spinal cord stimulation - SCS) je postupak kojim se ugrađuju jedna ili dvije elektrode u epiduralni prostor torakalne i lumbalne kralježnice te se elektrode spoje na bateriju koja isporučuje stimulaciju programiranu za tog bolesnika. SCS je indiciran kod bolesnika s jakom kroničnom boli koja se ne smanjuje primjenom ostalih oblika liječenja. Ovaj zahvat se radi kod bolesnika koji imaju bolove u lumbalnom dijelu kralježnice nakon neurokirurških zahvata na lumbalnoj kralježnici s posljedičnim stvaranjem priraslica, sa širenjem boli u donje ekstremitete ili bez širenja boli, kod bolesnika s bolovima nakon amputacije donjih ekstremiteta, te boli koja je posljedica kompleksnih regionalnih bolnih sindroma. U KBC-u Osijek tijekom 2017. g. postupak perkutane ugradnje elektroda za stimulator kralježnične moždine učinjen je kod 5 bolesnika. Prema našim saznanjima sve dosadašnje ugradnje stimulatora kralježnične moždine u Republici Hrvatskoj učinjene su kirurškim, a ne perkutanim pristupom. Bolesnike se procjenjivalo putem numeričke ljestvice za procjenu boli, Oswestry upitnika za procjenu stupnja invalidnosti, SF-36 upitnika za procjenu kvalitete života. Upitnici su ispunjavani prije zahvata, na kontrolnom pregledu prije ugradnje trajne stimulacije, te mjesec i tri mjeseca nakon ugradnje trajnog stimulatora. U ukupnim vrijednostima opaženo je značajno poboljšanje ocjene tjelesnog zdravlja, smanjenje stupnja invalidnosti kao i trenutni, prosječni i najjači intenzitet boli proteklih četiri tjedana u odnosu na prvu vizitu.Spinal cord stimulation (SCS) is a procedure of incorporating one or two electrodes into the epidural space of the thoracic and lumbar spine. The epidural space is located above the dura that covers the spinal cord. This procedure is performed in patients with pain in the lumbar spine with or without pain spreading to lower extremities, in patients with lower extremity amputation, and pain resulting from complex regional pain syndromes. SCS is indicated in patients with severe chronic pain that cannot be alleviated by other modes of treatment. Total SCS was performed in fi ve patients. Patients fi lled out a numerical scale assessing the intensity of pain, the Oswestry questionnaire assessing the degree of disability, and the SF36 questionnaire assessing the quality of life. The above-mentioned questionnaires were completed by the patients before implantation of permanent SCS, then one month after permanent SCS and 3 months of permanent SCS. The results showed signifi cant improvement in the quality of life at the 4th visit in almost all SF-36 items except for limiting the activity for physical health, emotional problems, and mental health. In the overall values, the improvement in physical health assessment with a median 33 (interquartile range from 30 to 59) was signifi cantly better as compared to the 15 (interquartile range from 11 to 16) on the fi rst visit (Friedman’s test, p=0.007). There was also a signifi cant reduction in the degree of disability, as well as in the current, average and most severe pain intensity lasting for four weeks compared to the fi rst visit