Estimulador de Medula Espinal: uma revisão integrativa de sua neurofisiologia, da difusão de seu uso e de sua eficácia no manejo da dor crônica

Spinal Cord Stimulator: an integrative review of its neurophysiology, the diffusion of its use and its effectiveness in the management of chronic pain

• Bárbara Rayne Santos de Alencar (1)    
• André Fernandes Mesquita (2)
• Ana Beatriz Pereira de Araújo Oliveira (1)
• Frederika Novaes Brito (1)
• Maria Eduarda Portela Veras Mascena (1)
• Lucas Rodrigues Barbosa Sousa (1)
• Bruno Sérgio Oliveira Pereira de Castro (1)
• Letícia Gaspar Magalhães Melo (1)
• Renato da Silva Santos (1)
• Ronaldo Cordeiro Brandão Filho (1)
• Gustavo Barbosa Carnaúba (3)
• Pedro Eduardo Gouveia Gonçalves de Oliveira (3)
• Yasmin Tourinho Delmondes Trindade (4)
• Yure Victor Nogueira da Silva (3)
• Francisco de Assis Vaz Guimarães Filho (5) (6)    

• https://doi.org/10.22290/jbnc.2023.340203
• J Bras Neurocirur 34 (2): 216-226, 2023

Resumo

Sabe-se que o estimulador de medula espinal (SCS) é historicamente relatado como tratamento alternativo na dor crônica refratária, por meio da estimulação de fibras nervosas específicas, A-beta, e da inibição dos impulsos dolorosos conduzidos pelas fibras C e A-delta, o que está de acordo com a teoria do portão da dor, proposta por Melzack e Wall. Além disso, há o aumento considerável de pacientes com dor crônica que precisam de um tratamento diferente do convencional. Graças aos estudos e aos avanços tecnológicos, o SCS tem ganhado popularidade, assim, a análise de seus possíveis mecanismos de ação, de seu uso e de seu nível de evidência, torna-se fundamental no campo da Neurocirurgia da Dor.

Palavras-chave

Estimulação da medula espinal; Dor crônica; Síndromes da dor regional complexa; Síndrome pós laminectomia; Angina refratária

Abstract

It is known that spinal cord stimulator (SCS) is historically reported as an alternative treatment in refractory chronic pain, through stimulation of specific nerve fibers, A-beta, and inhibition of painful impulses conducted by C and A-delta fibers , which is in agreement with the pain gate theory proposed by Melzack and Wall. In addition, there is a considerable increase in patients with chronic pain who need a treatment different from the conventional one. Thanks to studies and technological advances, SCS has gained popularity, thus, the analysis of its possible mechanisms of action, its use and its level of evidence becomes fundamental in the field of Pain Neurosurgery.

Keywords

Spinal cord stimulation; Chronic pain; Complex regional pain syndromes; Failed back surgery syndrome; Refractory angina

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1 Medical Student, Maurício de Nassau University Center – Uninassau, Recife, PE, Brazil.

2 Medical Student, Universidade de Rio Verde – UNIRV, Formosa, GO, Brazil.

3 Medical Student, Faculdade de Medicina Tiradentes – FITS, Jaboatão dos Guararapes, PE, Brazil.

4 Medical Student, Universidade Tiradentes – UNIT, Aracaju, SE, Brazil.

5 Neurosurgeon, Specialist in Minimally Invasive Surgery of the Brain and Spine, Director of RealNeuro, Instituto RealNeuro, Recife, PE, Brazil.

6 Advisor of the Academic League of Neurosurgery – LANEC, Centro Universitário Maurício de Nassau – UNINASSAU, Recife, PE, Brazil.

 

Received Dec 6, 2022

Corrected Jan 12, 2023

Accepted Jan 15, 2023