Early Clinical Outcome of Comparative Study between Revision Operation and Radiofrequency Treatment for Management of Failed Back Surgery Syndrome

Objective: Intractable back pain and radicular pain after lumbosacral spine surgery are challenges for surgeons because the pathophysiology of failed back surgery syndrome (FBSS) remains unknown. Various medications, exercise, reoperation, spinal cord stimulation, and various interventional treatments, such as epidural injection, and radiofrequency treatment, have been suggested as treatment options. However, the clinical outcomes for each treatment are unclear. Methods: We retrospectively evaluated clinical outcomes of consecutive FBSS patients who underwent revision operation or radiofrequency treatment from 2014 to 2017, who previously showed response to nerve block. Pain was analyzed preoperatively and 1 month, 6 months, and 12 months postoperatively using a visual analogue scale (VAS). Short Form 36 (SF-36) health survey and Oswestry Disability Index (ODI) scores were assessed preoperatively and 12 months postoperatively. Results: A total of 70 patients was included in the present study (33 males, 37 females). When comparing preoperative and postoperative 12-month results, back pain VAS score decreased from 5.5 to 4.2 for revision operation and from 5.1 to 4.7 for radiofrequency treatment. Leg pain VAS score decreased from 6.5 to 4.02 for revision operation and 6.2 to 4.3 for radiofrequency treatment. ODI score decreased from 70.9 to 36.1 for revision operation and 70.2 to 36.1 for radiofrequency treatment. SF-36 score increased from 28.9 to 64.1 for revision operation and from 29.6 to 59.6 for radiofrequency treatment. Differences between treatments were not statistically significant after 12 months (p>0.05) but were at 1 month (p=0.01). Conclusion: Compared with revision operation, radiofrequency treatment is not inferior on early clinical outcome (up to 1 year following the treatment) in terms of pain relief, functional capacity, patient satisfaction, and quality of life in patients with FBSS. Radiofrequency treatment can be considered in patients who are not good candidates for surgical treatment based on imaging results or underlying diseases and who are responsive to diagnostic/therapeutic nerve blocks.

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High-frequency spinal cord stimulation in failed back surgery syndrome patients with predominant low back pain—single-center experience

Neurosurgical Review ◽

10.1007/s10143-020-01462-5 ◽

2021 ◽

Author(s):

Stefan Motov ◽

Kaywan Aftahy ◽

Ann-Kathrin Jörger ◽

Arthur Wagner ◽

Bernhard Meyer ◽

...

Keyword(s):

Spinal Cord ◽

Low Back Pain ◽

Back Pain ◽

Spinal Cord Stimulation ◽

High Frequency ◽

Failed Back Surgery Syndrome ◽

Low Back ◽

Vas Score ◽

Failed Back Surgery ◽

Back Surgery

AbstractTreatment of patients with failed back surgery syndrome (FBSS) with predominant low back pain (LBP) remains challenging. High-frequency spinal cord stimulation (HF10 SCS) is believed to achieve significant pain reduction. We aimed to evaluate the real-life efficacy of HF-10 SCS in a tertiary spine center. A prospective observational study of all patients with FBSS and predominant LBP who underwent HF-10 SCS surgery was performed between 2016 and 2018. Patients > 18 years with Visual Analogue Scale (VAS) scores of ≥ 5 for LBP and pain duration > 6 months under stable medication were implanted percutaneous under general anesthesia and a trial phase of 7–14 days was accomplished. Primary end point was a successful trial defined as ≥ 50% VAS score reduction for LBP. Thirty-four of 39 (85%) subjects had a successful trial. Fifty-three percent were female and the mean age was 69 years. Median follow-up lasted for 10 months. Devices were removed after a median of 10 months in 5 cases. Remaining 29 patients stated significant VAS score reduction for LBP from 8.1 to 2.9 and VAS for leg pain from 4.9 to 2.2. Twenty-four percent of all patients were able to discontinue their opioids. Eight of 9 patients (89%) with signs of adjacent disc disease and 7 of 10 (70%) patients with hardware failure were successfully implanted with significant VAS reduction for LBP. HF-10 SCS achieves significant pain reduction in most patients with FBSS and predominant LBP. It might be an efficient alternative to revision surgery.

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Clinical outcome of instrumented fusion for the treatment of failed back surgery syndrome: a case series of 100 patients

Acta Neurochirurgica ◽

10.1007/s00701-012-1380-7 ◽

2012 ◽

Vol 154 (7) ◽

pp. 1213-1217 ◽

Cited By ~ 33

Author(s):

Mark P. Arts ◽

Nicola I. Kols ◽

Suzanne M. Onderwater ◽

Wilco C. Peul

Keyword(s):

Clinical Outcome ◽

Case Series ◽

Failed Back Surgery Syndrome ◽

Instrumented Fusion ◽

Failed Back Surgery ◽

Back Surgery

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

January 2018 - Pain Physician ◽

10.36076/ppj.2008/11/333 ◽

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

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Chronic Low Back Pain and Failed Back Surgery Syndrome

Neurosurgical Management of Pain ◽

10.1007/978-1-4612-1938-5_25 ◽

1997 ◽

pp. 340-349 ◽

Cited By ~ 1

Author(s):

Richard B. North

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Failed Back Surgery Syndrome ◽

Low Back ◽

Failed Back Surgery ◽

Back Surgery

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Clinical Outcome of Pulsed-Radiofrequency Combined With Transforaminal Epidural Steroid Injection for Lumbosacral Radicular Pain Caused by Distinct Etiology

Frontiers in Neuroscience ◽

10.3389/fnins.2021.683298 ◽

2021 ◽

Vol 15 ◽

Author(s):

Liuqing Yang ◽

Yuzhao Huang ◽

Jiahui Ma ◽

Zhenxing Li ◽

Rui Han ◽

...

Keyword(s):

Clinical Outcome ◽

Steroid Injection ◽

Failed Back Surgery Syndrome ◽

Radicular Pain ◽

Pulsed Radiofrequency ◽

Failed Back Surgery ◽

Back Surgery ◽

Transforaminal Epidural Steroid Injection ◽

Epidural Steroid

BackgroundLumbosacral radicular pain (LSRP) can be caused by disc herniation, spinal stenosis, and failed back surgery syndrome. The clinical effect of pulsed-radiofrequency (PRF) combined with transforaminal epidural steroid injection (TESI) for radiating pain in different population remains unclear.MethodsWe retrospectively reviewed the medical recordings of patients with LSRP caused by different etiologies, who underwent PRF and TESI treatment. The primary clinical outcome was assessed by a 10-point Visual Analog Scale (VAS) pre- and post-treatment.ResultsA total of 34 LSRP patients were identified and classified into 3 subgroups (disc herniation, spinal stenosis, and failed back surgery syndrome). The overall immediate pain reduction was 4.4 ± 1.1 after procedure. After a median follow-up of 9.5 months, the VAS decreased from 6.5 ± 1.0 to 2.4 ± 1.9 at the last follow-up.ConclusionPRF combined with TESI is an effective approach to treat persistent LSRP in distinct population.

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A Randomized Controlled Trial of Subcutaneous Nerve Stimulation for Back Pain Due to Failed Back Surgery Syndrome: The SubQStim Study

Neuromodulation Technology at the Neural Interface ◽

10.1111/ner.12784 ◽

2018 ◽

Vol 22 (5) ◽

pp. 519-528 ◽

Cited By ~ 6

Author(s):

Sam S. Eldabe ◽

Rod S. Taylor ◽

Stefaan Goossens ◽

Benedicte Bouche ◽

Ismail Gültuna ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Back Pain ◽

Nerve Stimulation ◽

Controlled Trial ◽

Failed Back Surgery Syndrome ◽

Randomized Controlled ◽

Failed Back Surgery ◽

Back Surgery

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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 ◽

10.1093/neuros/nyz310_418 ◽

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.

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