Failed back surgery syndrome: a new strategy by the epidural injection of MESNA

2017 ◽  
Vol 102 (2) ◽  
pp. 179-184 ◽  
Author(s):  
M. Carassiti ◽  
A. Di Martino ◽  
A. Centonze ◽  
C. C. Quattrocchi ◽  
A. Caldaria ◽  
...  
Keyword(s):  
Epidural Injection ◽  
Failed Back Surgery Syndrome ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
New Strategy

scholarly journals Analysis of Subdural Injection During Lumbar Interlaminar Epidural Injection in Failed Back Surgery Syndrome

2020 ◽  
Vol 9 (10) ◽  
pp. 3132
Author(s):  
Jin Young Lee ◽  
Woo Seog Sim ◽  
Ji Yeong Kim ◽  
Yu Ri Ko ◽  
So Young Lee ◽  
...  
Keyword(s):  
Spinal Surgery ◽  
Epidural Injection ◽  
Failed Back Surgery Syndrome ◽  
Leg Pain ◽  
Daily Life Activities ◽  
Pain Scores ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Before And After ◽  
Interlaminar Epidural Injection

Persistent or recurrent back and leg pain following spinal surgery, known as failed back surgery syndrome (FBSS), significantly limits daily life activities. A lumbar epidural injection can reduce adhesions, inflammation, and nerve compression, although the epidural space can be distorted due to dura mater and epidural tissues changes after spinal surgery. This study analyzed subdural injection during lumbar epidural injection in FBSS patients. We retrospectively analyzed data from 155 patients who received a lumbar interlaminar epidural injection to manage FBSS. We grouped the patients based on the injected contrast medium appearance in the subdural (group S) or epidural spaces (group E) in fluoroscopic contrast images. Demographic, clinical, surgical and fluoroscopic data were recorded and evaluated, as were the pain scores before and after injection. There were 59 patients (38.1%) in the subdural group. Injection distance from the surgery level differed between the groups. Risk of subdural injection at level 1 distance from the surgery level had an odds ratio of 0.374, and at level ≥2, it was 0.172, when compared to level 0. Subdural incidence differed with the distance from surgical site. Physicians should strive to reduce subdural incidence when the injection is planned at surgery site in FBSS.

scholarly journals Adjuvant Hyaluronidase to Epidural Steroid Improves the Quality of Analgesia in Failed Back Surgery Syndrome: A Prospective Randomized Clinical Trial

2014 ◽  
Vol 17;1 (1;17) ◽  
pp. E75-E82
Author(s):  
Nader Djalal Nader
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Epidural Injection ◽  
Failed Back Surgery Syndrome ◽  
Low Back ◽  
Analgesic Requirement ◽  
Pain Specialist ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Epidural Steroid

Background: Management of low back pain after spinal surgeries is one of the most challenging problems in pain medicine. Transforaminal lumbar epidural steroid injection has been used with inconsistent response. Most patients require multiple and frequent injections due to high recurrence of back pain. Objective: To find out whether the addition of hyaluronidase to the epidural injectate affects the quality and duration of analgesia in patients with low back pain secondary to failed back surgery syndrome. Study Design: Prospective randomized trial. Methods: The study was registered in the Government Clinical Trial registry and the protocol was reviewed and approved by the institutional review board. After obtaining an informed consent, 25 patients with low back pain due to failed back syndrome were randomly assigned to receive a transforaminal epidural injection of hyaluronidase 1500 IU (HYL) or normal saline (NSL) to a mixture of bupivacaine 0.5% (1 mL) and triamcinolone 40mg (1 mL) in a doubleblind fashion. An interventional pain specialist using fluoroscopic guidance performed all epidural injections. The patients received a comprehensive neurological examination by a non-interventional pain specialist who was blinded to the treatment during their follow-up visits, scheduled one, 2, and 4 weeks after the intervention. Numerical pain scores, analgesic requirement, and satisfaction scores were recorded during every visit. Results: There was no difference in demographic data between the 2 groups. Pain scores and total analgesic requirement were significantly lower in the HYL group at 2 and 4 weeks after blockade (P < 0.01). Patient satisfaction was higher in the HYL group. Limitations: The study was limited by a relatively small sample size. Conclusion: We conclude that adding hyaluronidase to the epidural injectate was effective in the management of chronic low back pain in patients with failed back surgery syndrome demonstrated over a period of 4 weeks. Key words: Low back pain, lumbar epidural injection, steroid, hyalorunidase, bupivacaine

scholarly journals Treatment Outcomes for Patients with Failed Back Surgery

2017 ◽  
Vol 1 (21;1) ◽  
pp. E29-E43 ◽  
Author(s):  
Jae Hwan Cho
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Back Pain ◽  
Spinal Cord Stimulation ◽  
Spinal Surgery ◽  
Epidural Injection ◽  
Failed Back Surgery Syndrome ◽  
Short Term ◽  
Failed Back Surgery ◽  
Back Surgery

Background: Failed back surgery syndrome (FBSS) is a frequently encountered disease entity following lumbar spinal surgery. Although many plausible reasons have been investigated, the exact pathophysiology remains unknown. Various medications, reoperations, interventions such as spinal cord stimulation, epidural adhesiolysis or epidural injection, exercise therapy, and psychotherapy have been suggested treatment options. However, the evidence of the clinical outcome for each treatment has not been clearly determined. Objectives: To evaluate the outcomes of each treatment modality and to present treatment guidelines for patients with FBSS. Study Design: A systematic review of each treatment regimen in patients with FBSS. Methods: The available literature regarding each modality for the treatment of refractory back pain or radiating pain for FBSS was reviewed. The quality assessment and the level of evidence were analyzed using the “Methodology Checklist” of SIGN (Scottish Intercollegiate Guidelines Network). Data sources included relevant English language literature identified through searches of Pubmed, EMBASE, and Cochrane library from 1980 to Feb 2016. The primary outcome measure was pain relief of back pain or radiating pain for at least 3 months. Secondary outcome measures were improvement of the patient’s functional status, health-related quality of life, return to work, and reduction of opioid use. Results: Twenty-three articles were finally identified and reviewed. Based on our analysis, epidural adhesiolysis showed a short-term (6 to 24 months) effect (grade A) and spinal cord stimulation showed a mid-term (2 or 3 years) effect (grade B). Epidural injections showed a short-term (up to 2 years) effect (grade C). However, other treatments were recommended as grade D or inconclusive. Limitations: The limitations of this systematic review included the rarity of relevant literature. Conclusions: Epidural adhesiolysis or spinal cord stimulation can be effective in order to control chronic back pain or leg pain due to FBSS, and its recommendation grades are A and B, respectively. Other treatments showed poor or inconclusive evidence. Key words: Failed back surgery syndrome, post spinal surgery syndrome, chronic low back pain, post lumbar surgery syndrome, epidural adhesiolysis, spinal cord stimulation, epidural injection, revision

scholarly journals The Effect of Dexmedetomidine on Lumbar Epidural Injection for Failed Back Surgery Syndrome

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Ashraf Eskandr ◽  
Sadik Abdel Maseeh
Keyword(s):  
Oswestry Disability Index ◽  
Epidural Injection ◽  
Failed Back Surgery Syndrome ◽  
Analgesic Requirement ◽  
Efficient Management ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Control Pain ◽  
Epidural Steroid ◽  
Group D

Purpose. Failed back surgery syndrome is a chronic pain condition requiring rapid, effective, and efficient management. This study evaluates the effect of adding dexmedetomidine to lumbar epidural steroids in patients with failed back surgery syndrome.Methods. Fifty patients suffering from failed back surgery syndrome were randomly assigned to one of two groups, receiving an epidural injection of 20 mL of either a mixture of betamethasone (14 mg) and bupivacaine 0.5 mg (group C) or a mixture of betamethasone (14 mg), bupivacaine 0.5 mg, and dexmedetomidine (0.5 μg/kg) (group D) adjusted to the volume with normal saline. The effect was evaluated using visual analogue scale (VAS), analgesic requirement, and Oswestry disability index 2 weeks, 4 weeks, 8 weeks, and 12 weeks after injection.Results. VAS and ibuprofen consumption showed a significant reduction in group D. The Oswestry disability index was significantly improved in group D. There were no records of hypotension, bradycardia, sedation, or hypoxemia in both groups.Conclusion. The present study demonstrated potential safe and effective usage of adding dexmedetomidine to epidural steroid to control pain in patients with failed back surgery syndrome.

scholarly journals The Effect of Hyaluronidase in Interlaminar Lumbar Epidural Injection for Failed Back Surgery Syndrome

2012 ◽  
Vol 36 (4) ◽  
pp. 466 ◽  
Author(s):  
Sang Beom Kim ◽  
Kyeong Woo Lee ◽  
Jong Hwa Lee ◽  
Min Ah Kim ◽  
Byoung Woo An
Keyword(s):  
Epidural Injection ◽  
Failed Back Surgery Syndrome ◽  
Failed Back Surgery ◽  
Back Surgery

Long-term quality of life and work status after high-dose spinal cord stimulation in patients with failed back surgery syndrome: a secondary analysis of real-world data

2020 ◽  
pp. 1-9
Author(s):  
Lisa Goudman ◽  
Ann De Smedt ◽  
Koen Putman ◽  
Maarten Moens ◽  
_ _
Keyword(s):  
Normal Population ◽  
Failed Back Surgery Syndrome ◽  
Work Status ◽  
High Dose ◽  
Difference Scores ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Vas Scores ◽  
Utility Scores

OBJECTIVEIn recent years, the use of high-dose spinal cord stimulation (HD-SCS) as a treatment option for patients with failed back surgery syndrome (FBSS) has drastically increased. However, to the authors’ knowledge a thorough evaluation of health-related quality of life (HRQOL) and work status in these patients has not yet been performed. Moreover, it is unclear whether patients who are treated with HD-SCS can regain the same levels of HRQOL as the general population. Therefore, the aims of this study were to compare the HRQOL of patients who receive HD-SCS to HRQOL values in an age- and sex-adjusted population without FBSS and to evaluate work status in patients who are receiving HD-SCS.METHODSHRQOL, measured with the 3-level EQ-5D (EQ-5D-3L), and work status were evaluated in 185 FBSS patients at baseline (i.e., before SCS) and at 1, 3, and 12 months of treatment with HD-SCS. Difference scores in utility values between patients and an age- and sex-adjusted normal population were calculated. One-sample Wilcoxon tests were used to assess the EQ-5D-3L difference scores. Mixed models were used to evaluate the evolution over time in EQ-5D-3L utility scores and EQ-5D visual analog scale (VAS) scores in patients and matched controls. Quality-adjusted life-years (QALYs) were calculated using the area under the curve method.RESULTSAn overall significant increase in EQ-5D-3L utility scores and EQ-5D VAS scores was found over time in the patient group. Wilcoxon tests indicated that the difference scores in utility values between patients and the normal population were significantly different from zero at all time points. The median incremental QALY after 12 months of HD-SCS was 0.228 (Q1–Q3: 0.005–0.487) in comparison to continued conservative treatment. At 12 months, 13.75% of patients resumed work.CONCLUSIONSHD-SCS may lead to significantly increased HRQOL at 12 months in patients with FBSS. Despite the increase, reaching the HRQOL level of matched controls was not achieved. Only a limited number of patients were able to return to work. This finding indicates that specialized programs to enhance return to work may be beneficial for patients undergoing SCS.

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