Percutaneous trial lead placement for failed back surgery syndrome

2020 ◽  
pp. 3-12
Author(s):  
Laura Lombardi-Karl ◽  
Musa Moris Aner
Keyword(s):  
Failed Back Surgery Syndrome ◽  
Lead Placement ◽  
Failed Back Surgery ◽  
Back Surgery

Multicolumn Spinal Cord Stimulation Lead Implantation Using an Optic Transligamentar Minimally Invasive Technique

Neurosurgery ◽  
2013 ◽  
Vol 73 (3) ◽  
pp. 550-553 ◽  
Author(s):  
Philippe Rigoard ◽  
Anh Tran Luong ◽  
Alexandre Delmotte ◽  
Mille Raaholt ◽  
Manuel Roulaud ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Failed Back Surgery Syndrome ◽  
Leg Pain ◽  
Invasive Technique ◽  
Lower Back ◽  
Lead Placement ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
New Generation

Abstract BACKGROUND: A new generation of neurostimulation surgical leads is used to increase the success of spinal cord stimulation in difficult-to-treat indications such as failed back surgery syndrome. Minimal access spinal technologies (MASTs) have previously been used for surgical lead implantation. However, only a unilateral approach was possible, causing difficulties for median lead placement, and not always preventing laminectomy. A recent MAST technique was used to implant spinal cord stimulation leads without these limitations. OBJECTIVE: To describe the MAST technique used in a pilot study. METHODS: Twenty-four consecutive patients were implanted with a multicolumn surgical lead for refractory chronic back and leg pain by using the optic transligamentar MAST technique. RESULTS: The MAST technique allowed median lead placement, facilitated visualization of the spine, and permitted transligamentar insertion that minimized scarring and muscle damage. No technique-related adverse events or lead revisions were reported. CONCLUSION: Use of a MAST approach could be useful in safe implantation of multicolumn surgical leads in difficult-to-treat, refractory lower back pain conditions such as failed back surgery syndrome.

Intrathecal Bleed Following Percutaneous Spinal Cord Stimulator Trial Lead Placement

2017 ◽  
pp. 105-111
Author(s):  
Ryan Nobles
Keyword(s):  
Spinal Cord ◽  
Failed Back Surgery Syndrome ◽  
Spinal Epidural Hematoma ◽  
Postanesthesia Care Unit ◽  
Spinal Cord Stimulator ◽  
Blood Products ◽  
Lead Placement ◽  
Patient Reported ◽  
Failed Back Surgery ◽  
Back Surgery

An intrathecal bleed is an exceedingly rare, yet potentially devastating consequence of accessing the epidural space for lead placement during a spinal cord stimulator trial. We present a case of radiologic evidence of intrathecal blood products and the neurologic consequences thereof following a percutaneous spinal cord stimulator trial. A 34-year-old man with a primary diagnosis of failed back surgery syndrome underwent percutaneous spinal cord stimulator lead placement. During the trial, the patient experienced paresthesia with initial right-side lead placement at T12-L1. The lead and needle were removed and placed at L1-2 where the patient did not report any problems. The patient reported right calf pain in the postanesthesia care unit following the trial that improved with intravenous hydromorphone. However, following discharge the patient experienced worsening dysesthesia with edema of the right lower extremity to the calf. Magnetic resonance imaging of the lumbar spine confirmed the presence of blood products within the intrathecal space. Spinal cord stimulator placement may be viewed as a safe and effective treatment modality despite the incidence of several neurologic, mechanical, and biologic complications. A few case reports discuss the occurrence of spinal epidural hematoma formation but none present a case of an intrathecal bleed following percutaneous spinal cord stimulator lead placement. This case report highlights the need to further elucidate the incidence of neurologic sequelae after spinal cord stimulator placement. Key words: Spinal cord stimulation, antiplatelets, anticoagulation, intrathecal bleed, complications, failed back surgery syndrome

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.

scholarly journals Persistent Spinal Pain Syndrome: a proposal for Failed Back Surgery Syndrome and ICD-11

Pain Medicine ◽  
2021 ◽  
Author(s):  
Nick Christelis ◽  
Brian Simpson ◽  
Marc Russo ◽  
Michael Stanton-Hicks ◽  
Giancarlo Barolat ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Spine Surgery ◽  
Pain Syndrome ◽  
Spinal Pain ◽  
Failed Back Surgery Syndrome ◽  
Medical Professionals ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Spinal Pain Syndrome

Abstract Objective For many medical professionals dealing with patients with persistent pain following spine surgery, the term failed back surgery syndrome (FBSS) as a diagnostic label is inadequate, misleading and potentially troublesome. It misrepresents causation. Alternative terms have been suggested but none has replaced FBSS. The International Association for the Study of Pain (IASP) published a revised classification of chronic pain, as part of the new International Classification of Diseases (ICD-11), which has been accepted by the World Health Organization (WHO). This includes the term Chronic pain after spinal surgery (CPSS), which is suggested as a replacement for FBSS. Methods This article provides arguments and rationale for a replacement definition. In order to propose a broadly applicable yet more precise and clinically informative term, an international group of experts was established. Results 14 candidate replacement terms were considered and ranked. The application of agreed criteria reduced this to a shortlist of four. A preferred option – Persistent spinal pain syndrome – was selected by a structured workshop and Delphi process. We provide rationale for using Persistent spinal pain syndrome and a schema for its incorporation into ICD-11. We propose the adoption of this term would strengthen the new ICD-11 classification. Conclusions This project is important to those in the fields of pain management, spine surgery and neuromodulation, as well as patients labelled with FBSS. Through a shift in perspective it could facilitate the application of the new ICD-11 classification and allow clearer discussion amongst medical professionals, industry, funding organisations, academia, and the legal profession.

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