Posterior fusion

2021 ◽  
pp. 209-234
Author(s):  
Cory Ullger ◽  
Mogana V. Jayakumar ◽  
Navdeep Jassal
Keyword(s):  
Back Pain ◽  
Sacroiliac Joint ◽  
Chronic Back Pain ◽  
Failed Back Surgery Syndrome ◽  
Posterolateral Approach ◽  
Safety And Efficacy ◽  
Minimally Invasive Surgical ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Sacroiliac Joint Fusion

Sacroiliac joint pain and dysfunction has increasingly been identified as an important pain generator in patients with chronic back pain or failed back surgery syndrome. It is estimated up to 30% of patients presenting with low back pain will have contributions from a painful sacroiliac joint. Historically, fusion of the joint has been performed with an open posterior or posterolateral approach. Minimally invasive surgical (MIS) approaches were introduced in 2008, and since that time MIS posterior and lateral approaches have become common. Numerous medical device companies have marketed MIS systems, and evidence of safety and efficacy is mounting. This chapter will detail the posterior approaches using fluoroscopic and navigation system guidance. Evidence for safety and efficacy of posterior sacroiliac joint fusion approaches will also be discussed.

Lateral fusion

2021 ◽  
pp. 193-208
Author(s):  
Gustaf Van Acker ◽  
Jonathon Belding ◽  
Chong H. Kim
Keyword(s):  
Back Pain ◽  
Sacroiliac Joint ◽  
Chronic Back Pain ◽  
Failed Back Surgery Syndrome ◽  
Posterolateral Approach ◽  
Open Approach ◽  
Safety And Efficacy ◽  
Minimally Invasive Surgical ◽  
Lateral Fusion ◽  
Sacroiliac Joint Fusion

Sacroiliac joint pain and dysfunction has increasingly been identified as an important pain generator in patients with chronic back pain or failed back surgery syndrome, and it is estimated to account for 15% to 30% of low back pain cases. Historically, fusion of the joint has been performed with an open posterior or posterolateral approach. Minimally invasive surgical (MIS) approaches were introduced in 2008, and since that time MIS posterior and lateral approaches have become common. Numerous medical device companies have marketed MIS systems, and evidence of their safety and efficacy is mounting. This chapter will detail lateral MIS approaches using fluoroscopic and navigation system guidance, as well as the posterolateral open approach, also known as the modified Smith-Petersen approach. Evidence for safety and efficacy of lateral sacroiliac joint fusion will also be discussed.

Efficacy of Transverse Tripolar Spinal Cord Stimulator for the Relief of Chronic Low Back Pain from Failed Back Surgery

2008 ◽  
Vol 3;11 (5;3) ◽  
pp. 333-338
Author(s):  
Asokumar Buvanendran
Keyword(s):  
Spinal Cord ◽  
Low Back Pain ◽  
Back Pain ◽  
Case Report ◽  
Pain Relief ◽  
Failed Back Surgery Syndrome ◽  
Low Back ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Stimulation Of

Background: Failed back surgery syndrome is a common clinical entity for which spinal cord stimulation has been found to be an effective mode of analgesia, but with variable success rates. Objective: To determine if focal stimulation of the dorsal columns with a transverse tripolar lead might achieve deeper penetration of the electrical stimulus into the spinal cord and therefore provide greater analgesia to the back. Design: Case report. Methods: We describe a 42-year-old female with failed back surgery syndrome that had greater back pain than leg pain. The tripolar lead configuration was achieved by placing percutaneously an octapolar lead in the spinal midline followed by 2 adjacent quadripolar leads, advanced to the T7-T10 vertebral bodies. Results: Tripolar stimulation pattern resulted in more than 70% pain relief in this patient during the screening trial, while stimulation of one or 2 electrodes only provided 20% pain relief. After implantation of a permanent tripolar electrode system with a single rechargeable battery, the pain relief was maintained for one year. Conclusion: This is case report describing a case of a patient with chronic low back pain with a diagnosis of failed back surgery syndrome in which transverse tripolar stimulation using an octapolar and 2 quadripolar leads appeared to be beneficial. The transverse tripolar system consists of a central cathode surrounded by anodes, using 3 leads. This arrangement may contribute to maximum dorsal column stimulation with minimal dorsal root stimulation and provide analgesia to the lower back. Key words: Epidural, low back pain, spinal cord stimulation, failed back surgery syndrome, tripolar stimulation

scholarly journals Complex Regional Pain Syndrome and Failed Back Surgery Syndrome With Failed High-Frequency Spinal Cord Stimulation Salvaged With Arthrodesis Revision Surgery and Burst Therapy

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Erin McCormack ◽  
Mansour H Mathkour ◽  
Lora Wallis Kahn ◽  
Maged Guirguis ◽  
Gassan Chaiban ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Back Pain ◽  
Pain Relief ◽  
High Frequency ◽  
Pain Syndrome ◽  
Failed Back Surgery Syndrome ◽  
Foot Pain ◽  
Failed Back Surgery ◽  
Back Surgery

Abstract INTRODUCTION Complex regional pain syndrome (CRPS) is a disabling form of constant and intense chronic pain involving a limb. Failed back surgery syndrome (FBSS) is chronic back pain following back surgery. Burst stimulation is a novel concept applied recently to treat chronic pain through spinal cord stimulation (SCS). The impulses are thought to travel to the thalamus to treat sensory, affective, and attentional components of neuropathic pain by targeting both the somatosensory cortex and the limbic system. METHODS A 50-yr-old female presented 1 yr after L5-S1 posterior instrumentation and posterolateral arthrodesis for spondylolisthesis with disabling Type I CRPS of her left foot and back pain. Postoperative improvement in back pain was noted but her left leg pain became worse despite SCS reprogramming. Two months later, she underwent placement of a different paddle lead at T12 and a new pulse generator using burst therapy. This resulted in complete resolution of foot pain. She remains pain-free 5 mo postoperatively. RESULTS Our patient underwent a T9-T10 high frequency (10 kHz) SCS trial followed by permanent paddle lead placement at T9-10 which provided more than 50% foot pain relief resulting in improved range of motion. However, worsening back pain and pseudoarthrosis mandated a revision of her prior arthrodesis 6 mo after SCS surgery. CONCLUSION In selected patients with FBSS and CRPS, revision of arthrodesis combined with SCS may be needed to achieve adequate pain relief. Burst therapy may be superior to high frequency stimulation in select patients.

scholarly journals Multicolumn spinal cord stimulation for predominant back pain in failed back surgery syndrome patients

Pain ◽  
2019 ◽  
Vol 160 (6) ◽  
pp. 1410-1420 ◽  
Author(s):  
Philippe Rigoard ◽  
Surajit Basu ◽  
Mehul Desai ◽  
Rod Taylor ◽  
Lieven Annemans ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Back Pain ◽  
Spinal Cord Stimulation ◽  
Failed Back Surgery Syndrome ◽  
Failed Back Surgery ◽  
Back Surgery
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