scholarly journals A 10-year follow-up of transpedicular screw fixation and intervertebral autogenous posterior iliac crest bone graft or intervertebral B-Twin system in failed back surgery syndrome

2015 ◽  
Vol 10 (2) ◽  
pp. 75 ◽  
Author(s):  
Rafael Cincu ◽  
Franciscode Asis Lorente ◽  
Joaquin Gomez ◽  
Jose Eiras ◽  
Amit Agrawal
Keyword(s):  
Iliac Crest ◽  
Screw Fixation ◽  
Failed Back Surgery Syndrome ◽  
Iliac Crest Bone Graft ◽  
Twin System ◽  
Transpedicular Screw ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Transpedicular Screw Fixation

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.

Spinal Cord Stimulation Electrode Design: A Prospective, Randomized, Controlled Trial Comparing Percutaneous with Laminectomy Electrodes: Part II–Clinical Outcomes

Neurosurgery ◽  
2005 ◽  
Vol 57 (5) ◽  
pp. 990-996 ◽  
Author(s):  
Richard B. North ◽  
David H. Kidd ◽  
Loredana Petrucci ◽  
Michael J. Dorsi
Keyword(s):  
Spinal Cord ◽  
Controlled Trial ◽  
Clinical Results ◽  
Failed Back Surgery Syndrome ◽  
Electrode Placement ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial ◽  
Failed Back Surgery ◽  
Back Surgery

Abstract OBJECTIVE: Spinal cord stimulation, in use for more than 30 years, has evolved into an easily implemented technique involving percutaneous or laminectomy electrode placement. In a randomized comparison of four-contact percutaneous and four-contact insulated laminectomy electrodes placed at the same level in the dorsal, epidural midline, quantitative measures of stimulator performance revealed significant technical advantages for the laminectomy electrodes. Our prospective, randomized, controlled trial compares clinical results in these same patients. METHODS: Impartial third parties followed our series of 24 patients with failed back surgery syndrome to gather clinical outcome data. We defined “success” as at least 50% sustained relief of pain and patient satisfaction with the result of treatment. RESULTS: At a mean follow-up of 1.9 years, 10 of 12 patients receiving the laminectomy electrode and 5 of 12 patients receiving the percutaneous electrode reported a successful outcome (P < 0.05). Follow-up at a mean of 2.9 years showed that this result was maintained in 5 of 12 patients with the laminectomy electrode and 3 of 12 with the percutaneous electrode (not statistically significant). Many patients reported improvements in most activities of daily living, and loss of function was rare. In addition, 9 patients with laminectomy electrodes and 4 with percutaneous electrodes reducted or eliminated analgesic intake (P < 0.05), and 2 returned to work. No electrode migration was observed. CONCLUSION: Laminectomy electrode placement, although more invasive than percutaneous placement, yields significantly better clinical results in patients with failed back surgery syndrome at mean 1.9 years follow-up. In our small sample, however, the statistical significance of this advantage disappeared at mean 2.9 years follow-up.

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

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.

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.

scholarly journals Effectiveness of Repetitive Transcranial Magnetic Stimulation in Patients With Failed Back Surgery Syndrome: A Double-Blind Randomized Placebo-Controlled Study

2020 ◽  
Vol 1;24 (1;1) ◽  
pp. E23-E30
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Controlled Trial ◽  
Failed Back Surgery Syndrome ◽  
Leg Pain ◽  
Double Blind ◽  
Failed Back Surgery ◽  
Back Surgery

BACKGROUND: Failed back surgery syndrome (FBSS) is the term of persistent back and/or leg pain after lumbar surgery. Repetitive transcranial magnetic stimulation (r-TMS) is a technique that allows noninvasive and relatively painless stimulation of cerebral cortex. It can reduce the experience of chronic pain by producing the small electrical currents in the cortex via magnetic field. OBJECTIVES: The aim of this study is to determine the effectiveness of r-TMS treatment on patients with FBSS. STUDY DESIGN: A double-blind, randomized, placebo-controlled trial. SETTING: The Physical Medicine and Rehabilitation Clinic of Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey. METHODS: In this double-blinded, randomized, placebo-controlled trial, 20 patients (aged 34–65 years) clinically diagnosed as FBSS who had a history of surgery for lumbar disc herniation with persistent back and leg pain were reviewed. Only patients with no root compression and/or spinal stenosis in postoperative magnetic resonance imaging of lumbar spine were included. Patients were randomly assigned to r-TMS (n:10) and sham (n:10) groups. Patients in the r-TMS group received 5 Hz of r-TMS as a 20-minute (1,000 pulses) daily session, 5 days per week, for a total of 10 sessions. r-TMS was applied with MagVenture device (MagPro X100, Denmark, 2009) and figure 8 coil (MMC 140 parabolic, MagVenture). Control group received sham r-TMS with the same protocol. Each patient was evaluated at baseline, days 5 and 10 of treatment, and 1 and 3 months after treatment. Visual Analog Scale (VAS), DN4 (Douleur Neuropathique en 4 Questions), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), and the Pittsburgh Sleep Quality Index (PSQI) were used for evaluation. RESULTS: There were no statistically significant differences between the groups for age, gender, number of surgeries, pain duration, working status, and drug usage. Significant improvements were achieved in DN4, ODI, BDI, and PSQI scores in the r-TMS group in comparison to the sham group. Both groups displayed improvements in VAS scores, whereas improvement in the sham group was limited to the first month. Achieved improvements in the r-TMS group in terms of VAS, DN4, ODI, BDI, and PSQI scores were sustained at the third month. LIMITATIONS: The limited number of patients and the short follow-up periods are the main limitations of our study. Further placebo-controlled studies with longer follow-up periods and greater number of cases would be beneficial for examining r-TMS application as a new treatment option in patients with FBSS. CONCLUSIONS: r-TMS might be an effective alternative treatment in patients with FBSS, further studies with larger groups are needed. KEY WORDS: Back pain, repetitive transcranial magnetic stimulation, failed back surgery syndrome, chronic back pain

scholarly journals Long-term Cost Utility of Spinal Cord Stimulation in Patients with Failed Back Surgery Syndrome

2017 ◽  
Vol 6 (20;6) ◽  
pp. E797-E805
Author(s):  
Shivanand P. Lad
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Failed Back Surgery Syndrome ◽  
Cost Utility ◽  
Conventional Management ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
One Year

Background: Failed back surgery syndrome (FBSS) is a cause of significant morbidity for up to 40% of patients following spine surgery, and is estimated to cost almost $20 billion. Treatment options for these patients currently include conventional medical management (CMM), repeat operation, or spinal cord stimulation (SCS). Much of the published data regarding cost effectiveness of SCS comprise smaller scale randomized controlled trials (RCTs) rather than large databases capturing practices throughout the US. SCS has been shown to have superior outcomes to CMM or repeat spinal operation in several landmark studies, yet there are few large studies examining its long-term economic impact. Objectives: This study compares health care utilization for SCS compared to other management in patients with FBSS. Study Design: Retrospective. Setting: Inpatient and outpatient sample. Methods: Patients with a history of FBSS from 2000 to 2012 were selected. We compared those who received SCS to those who underwent conventional management. A longitudinal analysis was used to model the value of log(cost) in each one year interval using a generalized estimating equations (GEE) model to account for the correlation of the same patient’s cost in multiple years. Similarly, a Poisson GEE model with the log link was applied to correlated count outcomes. Results: We identified 122,827 FBSS patients. Of these, 5,328 underwent SCS implantation (4.34%) and 117,499 underwent conventional management. Total annual costs decreased over time following implantation of the SCS system, with follow-up analysis at 1, 3, 6, and 9 years. The longitudinal GEE model demonstrated that placement of an SCS system was associated with an initial increase in total costs at the time of implantation (cost ratio [CR]: 1.74; 95% confidence interval [CI]: 1.41, 2.15, P < 0.001), however there was a significant and sustained 68% decrease in cost in the year following SCS placement (CR: 0.32; 95% CI: 0.24, 0.42, P < 0.001) compared to CMM. There was also an aggregate time trend that for each additional year after SCS, cost decreased on average 40% percent annually (CR: 0.60; 95% CI: 0.55, 0.65, P < 0.001), with follow-up up to 1, 3, 6, and 9 years post-procedure. Limitations: Costs are not correlated with patient outcomes, patients are not stratified in terms of complexity of prior back surgery, as well as inherent limitations of a retrospective analysis. Conclusions: We found that from 2000 to 2012, only 4.3% of patients across the United States with FBSS were treated with SCS. Long-term total annual costs for these patients were significantly reduced compared to patients with conventional management. Although implantation of an SCS system results in a short-term increase in costs at one year, the subsequent annual cumulative costs were significantly decreased long-term in the following 9 years after implantation. This study combines the largest group of FBSS patients studied to date along with the longest follow-up interval ever analyzed. Since SCS has repeatedly been shown to have superior efficacy to CMM in randomized clinical trials, the current study demonstrating improved long-term health economics at 1, 3, 6, and 9 years supports the long-term cost utility of SCS in the treatment of FBSS patients.

Failed Back Surgery Syndrome: 5-Year Follow-Up after Spinal Cord Stimulator Implantation

Neurosurgery ◽  
1991 ◽  
Vol 28 (5) ◽  
pp. 692-699 ◽  
Author(s):  
Richard B. North ◽  
Matthew G. Ewend ◽  
Michael T. Lawton ◽  
David H. Kidd ◽  
Steven Piantadosi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Failed Back Surgery Syndrome ◽  
Electrode Placement ◽  
Successful Outcome ◽  
Spinal Cord Stimulator ◽  
Long Term Outcome ◽  
Failed Back Surgery ◽  
Back Surgery

Abstract Spinal cord stimulation, in use for more than 20 years, has evolved into an easily implemented technique, with percutaneous methods for electrode placement. We have reviewed our experience with this technique in treating “failed back surgery syndrome,” and have assessed patient and treatment characteristics as predictors of long-term outcome. A series of 50 patients with failed back surgery syndrome (averaging 3.1 previous operations), who underwent spinal cord stimulator implantation, was interviewed by impartial third parties, at mean follow-up intervals of 2.2 years and 5.0 years. Successful outcome (at least 50% sustained relief of pain and patient satisfaction with the result) was recorded in 53% of patients at 2.2 years and in 47% of patients at 5.0 years postoperatively. Ten of 40 patients who were disabled preoperatively returned to work. Improvements in activities of daily living were recorded in most patients for most activities; loss of function was rare. 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 female patients and for those with programmable multi-contact implanted devices. These results, in patients with postsurgical lumbar arachnoid and epidural fibrosis and without surgically remediable lesions, compare favorably with the results in two separate series of patients with failed back surgery syndrome, in whom 1) surgical lesions were diagnosed and repeated operation performed; and 2) monoradicular pain syndromes were diagnosed and dorsal root ganglionectomies peroformed at our institution. This suggests the need for further assessment of selection criteria, critical analysis of treatment outcome, and prospective study of spinal cord stimulation and alternative approaches to failed back surgery syndrome.

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