One‐Year Results of an Algorithmic Approach to Managing Failed Back Surgery Syndrome

Avellanal, Martı́n; Diaz-Regañon, Gonzalo; Orts, A; Soto, Silvia

doi:10.1155/2014/474510

Cited by 32 publications

(36 citation statements)

References 15 publications

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“…FBSS is a challenging pain indication with various treatment options. For example, a recent review identified 8 different treatment modalities for FBSS, ranging from noninvasive to surgical, and a large prospective study of FBSS patients described an iterative 6‐step treatment algorithm requiring up to a year for implementation . It is likely that the wide variety of FBSS pain generators and the variability in pre‐ and postsurgical patient characteristics (some of which can only be identified in retrospect) contribute to the dissatisfying low rate of robust pain relief across all treatments.…”

Section: Discussionmentioning

confidence: 99%

Prospective Cohort Analysis of DRG Stimulation for Failed Back Surgery Syndrome Pain Following Lumbar Discectomy

et al. 2018

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Introduction Surgical lumbar discectomy is a commonly performed routine spinal procedure that is usually undertaken to alleviate lumbar radicular symptoms caused by a herniated intervertebral disc. Surgical lumbar discectomy can also lead to chronic postsurgical leg and/or back pain (failed back surgery syndrome [FBSS]), a condition that can be refractory to conventional medical management. Early clinical results on the use of dorsal root ganglion (DRG) stimulation for FBSS have supported the use of this treatment alternative. Methods A multicenter, single‐arm, observational cohort study enrolled patients who had chronic pain following surgical lumbar discectomy, had failed conservative treatments, and reported pain intensity of at least 6 out of 10 in the primary region of pain. Data were collected on pain, quality of life, disability, and mood at baseline and through 12 months. Results Thirteen patients underwent a trial of DRG stimulation; 11 (84.6%; 95% confidence interval = 57.8% to 95.7%) had good outcomes and underwent permanent device placement. Pain was reduced from a score of 8.64 (±0.92) at baseline to 2.40 (±2.38; n = 9) after 12 months of treatment, a 72.05% average reduction (P < 0.001). Similar improvements were observed across the secondary clinical measures, and safety data were in line with published rates. Discussion These results suggest that DRG stimulation induces pain relief in subjects diagnosed with FBSS. These reductions in pain were also associated with improvements in quality of life and disability. Additional prospective studies are warranted to further investigate this potential application of DRG stimulation, as well as to optimize patient selection, lead placement, and programming strategies.

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Section: Discussionmentioning

confidence: 99%

Prospective Cohort Analysis of DRG Stimulation for Failed Back Surgery Syndrome Pain Following Lumbar Discectomy

et al. 2018

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“…In support of this cut-off point for evaluation of procedural success; Avellanal et al 18 defined treatment success as ≥ 50% long-term pain relief maintained during the first year of follow-up. Also, Manchikanti et al 35 documented that the summary measure for pain was ≥ 50% reduction of pain in at least 50% of patients, or at least a threepoint decrease in pain scores; for disability scores the summary measure was ≥ 50% reduction in disability in at least 40% of …”

Section: Discussionmentioning

confidence: 99%

“…18 • Patients' satisfaction with the procedure was assessed using four-point scale questionnaire with 4 = very satisfied and 1 = very dissatisfied. Willingness to receive treatment again if pain persists or recurs was checked using a five-point scale questionnaire with 5 = definitely will and 1 = definitely will not.…”

Section: Evaluations Of Clinical Outcome Outcome Measuresmentioning

confidence: 99%

Management for failed back surgery syndrome: three-in-one procedure versus percutaneous spinal fixation alone

Mohamed

Salama

Salem

et al. 2017

Southern African Journal of Anaesthesia and Analgesia

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“…(35)(36)(37) que puede utilizarse en caso de problemas de acceso por el hiato sacro. Para realizar este procedimiento se inserta una aguja epidural 14g (tuohy, Coudé) en el espacio interlaminar L5-S1 con técnica de pérdida de resistencia y ayudados por fluoroscopia.…”

Section: Tiempo Quirúrgicounclassified

Epiduroscopia (interventional endoscopy spinal surgery): procedimiento endoscópico quirúrgico espinal

Iglesias

Nieto

2014

Rev. Soc. Esp. Dolor

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Nieto Iglesias C, Andrés Nieto I. Epiduroscopia (interventional endoscopy spinal surgery). Procedimiento endoscó-pico quirúrgico espinal. Rev Soc Esp Dolor 2014; 21(5): 281-293. INTRODUCCIÓNLa epiduroscopia, endoscopia espinal o también llamado IESS (interventional endoscopy spinal surgery -procedimiento endoscópico quirúrgico espinal) es un procedimiento de los llamados mínimamente invasivos, que permite visualizar el espacio epidural (en tiempo real) con fines diagnósticos y terapéuticos, en pacientes que padecen lumbalgia o lumbociatalgias crónicas refractarias a tratamientos convencionales, mediante la utilización de un epiduroscopio flexible, de pequeño tamaño, con una fibra óptica insertada y con la posibilidad de utilizar pequeños instrumentos para el tratamiento de los pacientes.La lumbalgia o lumbociatalgia se ha transformado en un grave problema sanitario y social ya que la incidencia anual afecta, en un 45 %, a la población de entre 35 y 50 años, constituyendo el 13 % de las causas de absentismo laboral, cifras que van en aumento exponencial, dada nuestra larga esperanza de vida. Lo cierto es que el 80-90 % de la población general padecerá este tipo de dolor alguna vez en la vida. Afortunadamente, estos episodios (60-80 %) ceden en el plazo de pocas semanas, pero alrededor de un 7-10 % desarrollarán dolor crónico (aunque para algunos autores esta cifra puede alcanzar hasta el 33 %) (1), lo que les hace subsidiarios de múltiples tratamientos médicos y quirúrgicos, que pueden fracasar, con un impacto brutal sobre su calidad de vida y estado funcional, así como un tremendo coste social (2).Según las diferentes publicaciones se considera que entre un 40 a un 80 % de los pacientes que han sufrido una intervención quirúrgica sobre la columna vertebral, mantendrán algún tipo de dolor e incluso empeorarán, o lo que es lo mismo, solo uno de cada cuatro experimentarán alguna mejoría. Este problema se denomina "síndrome de cirugía fallida de espalda" o en inglés "failed back surgery syndrome" (FBSS). Los peores resultados afectarán a aquellos pacientes que sufran más de una intervención (3). Este cuadro clínico, que consiste en la persistencia de dolor lumbar con o sin irradiación a miembros inferiores, constituye la mayor fuente de pacientes subsidiarios de esta técnica.El IESS ofrece una serie de ventajas sobre otros procedimientos, siendo poco agresivo y con escasas complicaciones, tales como:1. Visualización de tejidos normales y anormales (adherencias, inflamación…), tanto del espacio epidural posterior (espacio de trabajo habitual para la lisis de adherencias) como anterior. 2. Posibilidad de realización de biopsias. 3. Confirmación el diagnóstico del origen del dolor. 4. Lavado de sustancias proinflamatorias y algogénicas en el lugar de la lesión (mediante infusión de suero salino). 5. Depósito de sustancias terapéuticas en el lugar de la lesión (anestésicos locales, hialuronidasa, corticoides, ozono, clonidina…). 6. Lisis mecánica de adherencias (con balón o el propio epiduroscopio) y/o mediante la utili...

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One‐Year Results of an Algorithmic Approach to Managing Failed Back Surgery Syndrome

Cited by 32 publications

References 15 publications

Prospective Cohort Analysis of DRG Stimulation for Failed Back Surgery Syndrome Pain Following Lumbar Discectomy

Prospective Cohort Analysis of DRG Stimulation for Failed Back Surgery Syndrome Pain Following Lumbar Discectomy

Management for failed back surgery syndrome: three-in-one procedure versus percutaneous spinal fixation alone

Epiduroscopia (interventional endoscopy spinal surgery): procedimiento endoscópico quirúrgico espinal

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