scholarly journals Transforaminal Epiduroscopy in Patients with Failed Back Surgery Syndrome

2019 ◽  
Vol 1 (22;1) ◽  
pp. 89-95
Author(s):  
Martín Avellanal
Keyword(s):  
Rating Scale ◽  
Numeric Rating Scale ◽  
Failed Back Surgery Syndrome ◽  
University Hospital ◽  
Long Term Results ◽  
Control Group ◽  
Transforaminal Approach ◽  
Failed Back Surgery ◽  
Back Surgery

Background: Epiduroscopy is a useful diagnostic and therapeutic tool for managing failed back surgery syndrome (FBSS). The conventional approach is via either the sacral hiatus or the interlaminar. Major causes of FBSS include epidural fibrosis, disc herniation, and stenosis. When these problems are located at the intervertebral foramen level, it can be difficult to reach the lateral recess and the foramen with the epiduroscope. Transforaminal epiduroscopy could be a useful alternative approach in patients with FBSS located at the foraminal level. Objective: We present a new procedure for lumbar epiduroscopy via a transforaminal approach and its application in patients with FBSS. The technique is described and long-term results are reported. Study Design: This study used a single-arm prospective observational design. Setting: The research took place at the University Hospital in Spain. Methods: Patients with FBSS suffering severe chronic radicular pain (Numeric Rating Scale [NRS11] > 7) who had not responded to other treatments were included. Selective root stimulation during a pulsed radiofrequency procedure confirmed the origin of pain by means of an exact reproduction of typical pain. Transforaminal epiduroscopy was performed at the affected level. The severity of fibrosis observed was recorded. The NRS-11 score was reevaluated at 1, 6, and 12 months after the procedure. Any complications related to the treatment were recorded. Results: Twenty-four patients were included. The mean number of back surgeries was 1.66 (range, 1-5). The basal NRS-11 score was 7.83 (0.14); at 1 month, 3.66 (0.38) (P < 0.001); at 6 months, 4.46 (0.48) (P < 0.01); and at 1 year after treatment, 4.17 (0.51) (P < 0.01). Most patients (54%; 95% CI, 34%-74%) obtained > 50% pain reduction on the NRS-11, maintained during a 1-year follow-up period. No major complications were registered. Limitations: The research was limited by the lack of a control group. Conclusions: We have described a new procedure for epiduroscopy via the transforaminal approach. It is a useful and safe approach to managing FBSS at the foraminal level and shows better long-term results than other endoscopic procedures. Key words: Epidural, epiduroscopy, chronic pain, spinal cord, back surgery

Failed Back Surgery Syndrome: 5-Year Follow-Up in 102 Patients Undergoing Repeated Operation

Neurosurgery ◽  
1991 ◽  
Vol 28 (5) ◽  
pp. 685-691 ◽  
Author(s):  
Richard B. North ◽  
James N. Campbell ◽  
Carol S. James ◽  
Mary Kay Conover-Walker ◽  
Henry Wang ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Failed Back Surgery Syndrome ◽  
Long Term Results ◽  
Successful Outcome ◽  
Lumbosacral Spine ◽  
Long Term Outcome ◽  
Failed Back Surgery ◽  
Back Surgery

Abstract The indications for repeated operation in patients with persistent or recurrent pain after lumbosacral spine surgery are not well established. Long-term results have been reported infrequently, and in no case has mean follow-up exceeded 3 years. We report 5-year mean follow-up for a series of repeated operations performed between 1979 and 1983. Patient characteristics and modes of treatment have been assessed as predictors of long-term outcome. One hundred two patients with “failed back surgery syndrome” (averaging 2.4 previous operations), who underwent a repeated operation for lumbosacral decompression and/or stabilization, were interviewed by a disinterested third party a mean of 5.05 years postoperatively. Successful outcome (at least 50% sustained relief of pain for 2 years or at last follow-up, and patient satisfaction with the result) was recorded in 34% of patients. Twenty-one patients who were disabled preoperatively returned to work postoperatively; 15 who were working preoperatively became disabled or retired postoperatively. Improvements in activities of daily living were recorded, overall, as often as decrements. Loss of neurological function (strength, sensation, bowel and bladder control) was reported by patients more often than improvement. Most patients reduced or eliminated analgesic intake. Statistical analysis (including univariate and multivariate logistic regression) of patient characteristics as prognostic factors showed significant advantages for young patients and for female patients. Favorable outcome also was associated with a history of good results from previous operations, with the absence of epidural scar requiring surgical lysis, with employment before surgery, and with predominance of radicular (as opposed to axial) pain. These results suggest that selection criteria for repeated operation on the lumbosacral spine require further refinement, together with critical analysis of treatment outcome, and that alternative approaches to failed back surgery syndrome should be considered.

scholarly journals Long-Term Follow-Up of Inpatients with Failed Back Surgery Syndrome Who Received Integrative Korean Medicine Treatment: A Retrospective Analysis and Questionnaire Survey Study

2021 ◽  
Vol 10 (8) ◽  
pp. 1703
Author(s):  
Ju-Hun Park ◽  
Kang-Eah Choi ◽  
Sang-Gyun Kim ◽  
Hui-Yeong Chu ◽  
Sang-Woon Lee ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Questionnaire Survey ◽  
Failed Back Surgery Syndrome ◽  
Post Treatment ◽  
Leg Pain ◽  
Korean Medicine ◽  
Failed Back Surgery ◽  
Back Surgery

Introduction: this study aimed to investigate the long-term clinical efficacy and satisfaction degree of integrative Korean medicine (KM) treatment for patients with failed back surgery syndrome (FBSS). Methods: we performed a follow-up questionnaire survey and retrospective analysis of medical records for patients with FBSS who underwent inpatient treatment for ≥ 1 week. The primary evaluation indices were numeric rating scale (NRS) scores for low back pain (LBP) and leg pain at admission and discharge. Sub-evaluation indices included the Oswestry Disability Index (ODI) and EuroQol 5-dimension (EQ-5D) score. The follow-up questionnaire survey obtained information regarding previous surgeries; reasons for satisfaction/dissatisfaction with surgical and KM treatment; and current status. Results: compared with at admission, there was a significant post-treatment decrease in the NRS scores for LBP and leg pain, as well as the ODI score. Further, there was a significant post-treatment increase in the EQ-5D score. Regarding the patients’ global impression of change for KM treatment administered during admission and at the follow-up questionnaire survey, 101 (95.3%) patients selected “minimally improved” or better. Conclusion: integrative KM treatment could effectively reduce pain, as well as improve function and health-related quality of life, in patients with FBSS.

The Outcome of Pulsed Radiofrequency Treatment According to Electodiagnosis in Patients with Intractable Lumbosacral Radicular Pain

Pain Medicine ◽  
2019 ◽  
Vol 20 (9) ◽  
pp. 1697-1701
Author(s):  
Chan Hong Park ◽  
Sang Ho Lee
Keyword(s):  
Rating Scale ◽  
Numeric Rating Scale ◽  
Failed Back Surgery Syndrome ◽  
Radicular Pain ◽  
Spinal Nerve ◽  
Pulsed Radiofrequency ◽  
Pulsed Radiofrequency Treatment ◽  
Significant Difference ◽  
Failed Back Surgery ◽  
Group 2

AbstractBackgroundRadicular pain is related to lesions that either directly compromise the dorsal root ganglion (DRG) or indirectly compromise the spinal nerve and its roots by causing ischemia or inflammation of the axons.ObjectiveOur study aimed to assess the outcomes of pulsed readiofrequency treatment (PRF) according to electrodiagnosis results in patients with chronic intractable lumbosacral radicular pain.MethodsA total of 82 failed back surgery syndrome (FBSS) patients were included in this study. All of them underwent electromyography/nerve conduction studies before pulsed radiofrequency (PRF) treatment at the DRG, and they were classified according to the electrodiagnostic results as: group 1, no definite finding (normal); group 2, radiculopathy; and group 3, neuropathy. Pain intensity was assessed according to a numeric rating scale score and the Oswestry Disability Index (ODI) before treatment and at one, three, six, and 12 months after treatment, and successful treatment was defined as a pain score reduction of ≥50% at 12 months, as compared with the pretreatment score.ResultsPretreatment electrodiagnosis identified 28 patients with no definite findings, 31 patients with radiculopathy, and 23 patients with neuropathy. The patients with neuropathy had less pain relief after treatment than those with no definite findings and those with radiculopathy. The prevalence of pain reduction of at least 50% was lower in the neuropathy group than in the other groups. There was no statistically significant difference in ODI between group.ConclusionOutcomes after PRF at the DRG did not show strong differences according to electrodiagnostic findings in FBSS patients with chronic intractable lumbosacral radicular pain.

Long-Term Outcome of Spinal Cord Stimulation in Failed Back Surgery Syndrome: 20 Years of Experience With 224 Consecutive Patients

Neurosurgery ◽  
2018 ◽  
Vol 84 (5) ◽  
pp. 1011-1018 ◽  
Author(s):  
Mette Nissen ◽  
Tiina-Mari Ikäheimo ◽  
Jukka Huttunen ◽  
Ville Leinonen ◽  
Mikael von und zu Fraunberg
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Spinal Cord Stimulation ◽  
Failed Back Surgery Syndrome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Failed Back Surgery ◽  
Back Surgery

Abstract BACKGROUND Failed back surgery syndrome (FBSS) is a challenging condition that lacks a curative treatment. In selected patients, spinal cord stimulation (SCS) has provided a satisfactory outcome. OBJECTIVE To evaluate the long-term outcome of SCS in FBSS, as measured by (1) the explantation rate, (2) complications, and (3) patient satisfaction with the global perceived effect (GPE). METHODS We studied 224 consecutive FBSS patients who underwent an SCS trial with surgically implanted leads at our hospital between January 1996 and December 2014. The patients’ satisfaction with the GPE of treatment was measured through a postal questionnaire at the end of follow-up. RESULTS Based on a 1-wk trial, permanent SCS was implanted in 175 (78%) patients. Out of these patients, 153 (87%) reported satisfactory outcomes after 2 mo. During the mean follow-up of 6 yr, 34 (19%) of SCS devices were permanently explanted due to inadequate pain relief, and 11 (6%) were explanted for other reasons. Electrode revision due to inadequate pain relief was done for 22 patients. In total, 26 complications were reported due to: 7 deep infections, 11 hardware malfunctions, 1 subcutaneous hematoma, 4 instances of discomfort due to the pulse generator, and 3 electrode migrations. One hundred thirty patients (74%) continued with SCS until the end of follow-up. Of them, 61 (47%) returned the questionnaire, and 42 (69%) reported substantially improved or better GPE. CONCLUSION SCS can provide a good outcome in the treatment of FBSS. Patient selection could be further improved by developing novel predictive biomarkers.

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