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One-Year Results of an Algorithmic Approach to Managing Failed Back Surgery Syndrome
- Source :
- Pain Research and Management, Vol 19, Iss 6, Pp 313-316 (2014), Pain Research & Management : The Journal of the Canadian Pain Society
- Publication Year :
- 2014
- Publisher :
- Hindawi Limited, 2014.
-
Abstract
- Failed back surgery syndrome refers to persistent back pain following back surgery. The optimal course of treatment for this syndrome varies according to the patient and the etiology of the pain. This study describes the application of a treatment algorithm for failed back surgery syndrome, focusing on the use of epiduroscopy, a novel technique that is useful for diagnosis and treatment of this syndrome. Diagnoses and treatment success after one year of follow-up are reported.<br />BACKGROUND: Failed back surgery syndrome (FBSS) is a major clinical problem. Different etiologies with different incidence rates have been proposed. There are currently no standards regarding the management of these patients. Epiduroscopy is an endoscopic technique that may play a role in the management of FBSS. OBJECTIVE: To evaluate an algorithm for management of severe FBSS including epiduroscopy as a diagnostic and therapeutic tool. METHODS: A total of 133 patients with severe symptoms of FBSS (visual analogue scale score ≥7) and no response to pharmacological treatment and physical therapy were included. A six-step management algorithm was applied. Data, including patient demographics, pain and surgical procedure, were analyzed. In all cases, one or more objective causes of pain were established. Treatment success was defined as ≥50% long-term pain relief maintained during the first year of follow-up. Final allocation of patients was registered: good outcome with conservative treatment, surgical reintervention and palliative treatment with implantable devices. RESULTS: Of 122 patients enrolled, 59.84% underwent instrumented surgery and 40.16% a noninstrumented procedure. Most (64.75%) experienced significant pain relief with conventional pain clinic treatments; 15.57% required surgical treatment. Palliative spinal cord stimulation and spinal analgesia were applied in 9.84% and 2.46% of the cases, respectively. The most common diagnosis was epidural fibrosis, followed by disc herniation, global or lateral stenosis, and foraminal stenosis. CONCLUSIONS: A new six-step ladder approach to severe FBSS management that includes epiduroscopy was analyzed. Etiologies are accurately described and a useful role of epiduroscopy was confirmed.
- Subjects :
- Adult
Male
medicine.medical_specialty
Young Adult
health services administration
Failed back surgery
medicine
Humans
Failed Back Surgery Syndrome
health care economics and organizations
Aged
Epiduroscopy
Aged, 80 and over
Spinal cord
lcsh:R5-920
business.industry
General surgery
Middle Aged
equipment and supplies
Pain management
Surgery
Anesthesiology and Pain Medicine
Neurology
Etiology
population characteristics
Female
Original Article
lcsh:Medicine (General)
business
human activities
Algorithms
Subjects
Details
- ISSN :
- 12036765
- Volume :
- 19
- Database :
- OpenAIRE
- Journal :
- Pain Research and Management
- Accession number :
- edsair.doi.dedup.....e4b6f852deaa6ff3e678b61f588006b6