scholarly journals Neuromodulation in the Treatment of Postoperative Epidural Fibrosis: Comparison of the Extent of Epidural Fibrosis and the Effect of Stimulation

2021 ◽  
pp. 461-468
Author(s):  
V MASOPUST ◽  
J HOLUBOVÁ ◽  
P SKALICKÝ ◽  
R ROKYTA ◽  
J FRICOVÁ ◽  
...  
Keyword(s):  
Failed Back Surgery Syndrome ◽  
Dorsal Column ◽  
Implantation Technique ◽  
Epidural Fibrosis ◽  
Study Objective ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Lumbar Spinal ◽  
Dorsal Column Stimulation ◽  
Group 1

The goal was to prove that when a cohort of patients is chosen precisely, dorsal column stimulation provides significant improvement to quality of life. We studied a cohort of 50 patients with the history of failed back surgery syndrome coupled with epidural fibrosis (EF). A percutaneous implantation technique was used in each of the 50 patients. The study group was composed of 20 women and 28 men aged 26-67 years (mean age 49). A prospective observational questionnaire-based study was used. According to the methods, Ross's classification was adjusted to four degrees of scar size for our study objective. Despite this adjustment, it was not possible to statistically evaluate our research, due to very similar results in Groups I, III and IV. Patients without epidural fibrosis were assigned to Group 0, and patients with EF of different ranges were assigned to Group 1. The mean change in visual analogue scale ΔVAS after our division into Group 0 was 4.82; for Group 1 it was 6.13. Evaluation of EF and ΔVAS correlation by paired t-test shows a statistically higher effect of spinal cord stimulation (SCS) in the epidural fibrosis group, compared to group 0 without postope-rative epidural fibrosis (p=0.008). The extent of epidural fibrosis is an important factor for Failed back surgery syndrome (FBSS). FBSS is the basis for the existence of neuropathic pain after lumbar spinal surgery. There is clear evidence of a correlation between patients with epidural scar formation on MR scan and the effect of dorsal column stimulation.

Advances in Dorsal Column Stimulation

2018 ◽  
Author(s):  
Chirag D. Shah ◽  
Maunak V. Rana
Keyword(s):  
Pain Syndrome ◽  
Failed Back Surgery Syndrome ◽  
Dorsal Column ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Evidenced Based ◽  
Technological Improvements ◽  
Based Medicine ◽  
Dorsal Column Stimulation ◽  
Evidenced Based Medicine

Spinal cord stimulation (SCS) has been a long established therapy for various pain conditions including low back pain, failed back surgery syndrome, complex regional pain syndrome, and other neuropathic and nociceptive pain states. Since the first report of SCS in 1967 by Shealy, advances have occurred in the technology used to achieve clinical analgesia. Developments in both the hardware and software involved have led to significant improvements in functional specificity, as seen in dorsal root ganglion stimulation, along with increasing breadth and depth of the field of neuromodulation. The patient experience during the implantation of the systems, as well as post-procedurally has been enhanced with improvements in programming. These technological improvements have been validated in quality evidenced-based medicine: what was a static area now is a dynamic field, with neuromodulation poised to allow physicians and patients more viable options for better pain control for chronic painful conditions.

Mitomycin C in preventing spinal epidural fibrosis in a laminectomy model in rats

2004 ◽  
Vol 100 (1) ◽  
pp. 52-55 ◽  
Author(s):  
Jin-Yul Lee ◽  
Werner Stenzel ◽  
Heinrich Ebel ◽  
Christoph Wedekind ◽  
Ralf-Ingo Ernestus ◽  
...  
Keyword(s):  
Mitomycin C ◽  
Spinal Column ◽  
Failed Back Surgery Syndrome ◽  
Epidural Fibrosis ◽  
En Bloc ◽  
Content Type ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Spinal Epidural ◽  
Fine Print

Object. Extensive epidural fibrosis after lumbar surgery may be the underlying cause in most cases of failed—back surgery syndrome. Various materials have been used to prevent epidural fibrosis, but only moderate success has been shown. Mitomycin C, an alkylosing antibiotic substance isolated from Streptomyces caespitosus, potentially supresses fibroblast proliferation after surgery. In this study, the authors investigated the effect of mitomycin C by local application on spinal epidural fibrosis in a rat laminectomy model. Methods. Five Wistar rats underwent laminectomy at cervical, thoracic, and lumbar levels. Based on data obtained from ophthalmological studies, mitomycin C was applied to the laminectomy sites in various concentrations (0.01, 0.05, and 0.1 mg/ml). One laminectomy site in each rat was left untreated and thus served as a control. Evoked potentials were measured pre- and postoperatively, and all rats underwent clinical evaluation. Mobility status and evidence of neurological deficit were recorded. Twelve weeks later, the rats were killed, and the spinal column, including surrounding muscle tissue, was removed en bloc, decalcified, and fixed in formaldehyde. Epidural fibrosis was evaluated histologically. In all mitomycin C—treated laminectomy sites, epidural scarring was significantly reduced compared with control sites. Remarkably, dural adhesions were absent in laminectomy defects treated with mitomycin C concentrations of 0.05 and 0.1 mg/ml. Moderate to marked epidural fibrosis with adhesion to the dura mater was noted at sites receiving 0.01 mg/ml of mitomycin C. All control sites showed dense epidural fibrosis with marked dura adherence. Conclusions. In this experimental model, mitomycin C applied locally at a concentration of 0.1 mg/ml effectively reduced epidural fibrosis, completely avoided dural adherence, and induced no side effects.

Application of spinal cord stimulation in the treatment of persistent pain in failed back surgery syndrome

2018 ◽  
Vol 20 (2) ◽  
pp. 43-49
Author(s):  
A. В. Dmitriev ◽  
D. A. Rzaev ◽  
N. P. Denisova
Keyword(s):  
Spinal Cord ◽  
Hospital Discharge ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome ◽  
Failed Back Surgery Syndrome ◽  
Drug Resistant ◽  
Neurogenic Pain ◽  
Study Objective ◽  
Failed Back Surgery ◽  
Back Surgery

The study objectiveis to demonstrate our experience of the spinal cord stimulation in the treatment of drug-resistant pain in patients with the failed back surgery syndrome (FBSS) and to evaluate its effectiveness and complications.Materials and methods.Systems for chronic spinal cord stimulation were implanted in 78 patients suffering from FBSS in Federal Neurosurgical Center (Novosibirsk) during 2013–2015. All patients had a drug-resistant neurogenic pain syndrome character and were undergone surgical intervention on the spine. Evaluating of the treatment effectiveness was carried out by visual analogue scale (VAS) and a scale Douleur Neuropathique en 4 Questions (DN4). Catamnesis ranged from 6 to 18 months.Results.The median preoperative VAS score evaluation was 6.7, at hospital discharge – 3.1, after 6 months – 3.2, after 12 months – 3.5, after 18 months – 3.4. Evaluation on a scale DN4 before surgery was 5.3, at hospital discharge – 2.1, after 6 months – 2.4, after 12 months – 2.5, after 18 months – 2.4. Complications in the form of migration, fracture of the electrodes and development of hemorrhage or inflammation at the site of implantation of the system were observed in 12 (15.3 %) cases and required revision surgery.Conclusion.Spinal stimulation is an effective and safe method of treatment of pain in FBSS, but it has specific complications associated with implantable systems.

scholarly journals Sensor driven-position adaptive versus conventional spinal cord stimulation in failed back surgery syndrome: a retrospective case series

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Mert Akbas ◽  
Haitham Hamdy Salem ◽  
Tamer Hussien Emara ◽  
Bora Dinc ◽  
Bilge Karsli
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Case Series ◽  
Failed Back Surgery Syndrome ◽  
Retrospective Case ◽  
Treatment Groups ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Group 2 ◽  
Group 1

Abstract Background Failed back surgery syndrome (FBSS) is a common problem affecting 20–40% of cases undergoing spine surgeries. Spinal cord stimulation (SCS) has been shown to be an efficient and relatively safe treatment in managing many intractable chronic pain syndromes. Objectives This study compares the efficacy and safety of MR-compatible sensor driven-position adaptive SCS and conventional SCS in treating FBSS. Methods This is a retrospective case series of 120 consecutive FBSS patients who underwent SCS between February 2011 and March 2018. Pain levels, analgesic/opioid use, and sleep problems were assessed before and 3 months after the procedure in patients who received either conventional SCS (group 1; n = 62) or sensor-driven position adaptive SCS (group 2; n = 34). The degree of patient satisfaction, the change in the activities of daily living (ADLs) together with the rate of complications were compared in both treatment groups. Results The two treatment groups were homogenous at baseline. Patients in both groups improved significantly regarding pain, opioid consumption, sleep, and ADLs. The magnitude of improvement was statistically higher in group 2. An absolute reduction of 6 points on the VAS in patients who received position adaptive SCS vs a 3.3 point reduction in conventional SCS cases (p < 0.0001). Half of the patients in group 2 (n = 17) showed excellent satisfaction after the procedure versus 14.5% of cases in group 1 (n = 9). Conclusion SCS is an efficient and reliable treatment in FBSS. MR-compatible sensor driven-position adaptive SCS can be a more effective treatment in this patient group.

scholarly journals Celecoxib-Loaded Electrospun Fibrous Antiadhesion Membranes Reduce COX-2/PGE2 Induced Inflammation and Epidural Fibrosis in a Rat Failed Back Surgery Syndrome Model

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Wei Wang ◽  
Yunhao Wang ◽  
Tengfei Lou ◽  
Mingqian Ding ◽  
Juehong Li ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Surgery ◽  
Failed Back Surgery Syndrome ◽  
Surgical Trauma ◽  
Epidural Fibrosis ◽  
Resonance Imaging ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Cox 2 ◽  
Fibrous Membranes

To date, failed back surgery syndrome (FBSS) remains a therapy-refractory clinical condition after spinal surgery. The antiadhesion membrane is applied to prevent FBSS by isolating fibrosis; however, the inflammation stimulated by the foreign body and surgical trauma needs to be further resolved simultaneously. Therefore, we developed new electrospun polycaprolactone (PCL) fibrous membranes loaded with celecoxib (CEL) to prevent fibrosis and inflammation associated with FBSS. The CEL-loaded PCL fibers were randomly distributed, and the drug was released over two weeks. Fluorescence micrographs revealed that the fibroblasts proliferated less on the PCL-CEL fibrous membranes than in the PCL group and the blank control. In the rat laminectomy model after 4 weeks, magnetic resonance imaging of epidural fibrosis was least in the PCL-CEL group. Expression of COX-2 and PGE2 was lower in the PCL-CEL group. It concluded that the CEL-loaded PCL membrane could reduce fibrosis and inflammation in a rat model of FBSS via COX-2/PGE2 signaling pathways.

scholarly journals Systematic Review of Percutaneous Adhesiolysis and Management of Chronic Low Back Pain in Post Lumbar Surgery Syndrome

2009 ◽  
Vol 2;12 (2;3) ◽  
pp. 361-378 ◽  
Author(s):  
Richard Epter
Keyword(s):  
Chronic Low Back Pain ◽  
Observational Studies ◽  
Randomized Trials ◽  
Failed Back Surgery Syndrome ◽  
Epidural Fibrosis ◽  
Low Back ◽  
Lumbar Surgery ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Level I

Background: Post lumbar surgery syndrome or failed back surgery syndrome with persistent pain continues to increase over the years. The speculated causes of post lumbar laminectomy syndrome include acquired stenosis, epidural fibrosis, arachnoiditis, radiculopathy, and recurrent disc herniation. Epidural fibrosis may account for as much as 20% to 36% of all cases of failed back surgery syndrome. Percutaneous epidural adhesiolysis has been employed in interventional pain management in the treatment of chronic, refractory low back and lower extremity pain after back surgery. Study Design: A systematic review of randomized trials and observational studies. Objective: To evaluate the effectiveness of percutaneous adhesiolysis in managing chronic low back and lower extremity pain due to post lumbar surgery syndrome. Methods: A comprehensive literature search was conducted utilizing electronic databases, as well as systematic reviews and cross references from 1966 through December 2008. The quality of individual articles used in this analysis was assessed by modified Cochrane review criteria for randomized trials and the Agency for Healthcare Research and Quality (AHRQ) criteria for assessment of observational studies. Clinical relevance was evaluated using 5 questions according to the criteria recommended by the Cochrane Review Back Group. Analysis was conducted using 5 levels of evidence, ranging from Level I to III, with 3 subcategories in Level II. Outcome Parameters: The primary outcome measure was pain relief (short-term relief of at least 6 months and long-term relief of more than 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and change in opioid intake. Results: Of the 13 studies considered for inclusion, 3 randomized trials and 4 observational studies met the inclusion criteria for methodologic quality assessment and evidence synthesis based on methodologic quality scores of 50 or more. Evidence of percutaneous adhesiolysis in the management of chronic low back pain in post-lumbar surgery syndrome is Level I to Level II1, with evidence derived from 3 randomized trials. Limitations: There is a paucity of efficacy and pragmatic trials. No trials have been published after 2006. Conclusion: The indicated level of evidence for percutaneous adhesiolysis is Level I or II-1 based on the US Preventative Services Task Force (USPSTF) criteria. Key words: Chronic low back pain, post lumbar surgery syndrome, post surgery syndrome, failed back surgery syndrome, spinal stenosis, epidural fibrosis, interventional techniques, percutaneous adhesiolysis, hypertonic saline neurolysis

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