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Search Results for : Failed Low Back Surgery Syndrome
Merck Online Lab
Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
[Failed back syndrome in patients after the surgery for compressive lumbosacral radiculopathy]
Author(s): Esin, RG; Danilov, VI; Minkina, ISh; Esin, OR
Journal: Zh Nevrol Psikhiatr Im S S Korsakova 2010 Mar 12; Vol. 109, Issue 11; Page(s) 37-41
[Medline ID - 20032952]

A study of 80 patients after the surgery for compressive lumbosacral radiculopathy revealed that myogenic trigger zones and skin zones of hyperalgesia in lumbar and low extremities on the side of radicular compression and the contralateral side were formed before the surgery. Trigger zones remained in the latent state after the surgery in 33 patients who had no anxiety and depressive symptoms before the operation. These zones were treated with exercises (a fitness program). Symptoms of anxiety and depression that predict the relapse of pain in the post-surgery period were noted in 47 patients. The relapse of pain followed the < < blazed way > > in these patients but it was caused by the pain conditioned by trigger zones formed before the surgery in the insufficiency of the antinociceptive system. Moreover, an iatrogenic zone emerged in the post-surgery scar. Treatment of this group of patients should include antidepressants (velaxin), local anesthetics (novocaine, plasters with 5% lidocaine gel) and later - a fitness program.

A comparative effectiveness evaluation of percutaneous adhesiolysis and epidural steroid injections in managing lumbar post surgery syndrome: a randomized, equivalence controlled trial.
Author(s): Manchikanti, L; Singh, V; Cash, KA; Pampati, V; Datta, S
Journal: Pain Physician 2010 Feb 23; Vol. 12, Issue 6; Page(s) E355-68
[Medline ID - 19935992]

BACKGROUND: Speculated causes of post lumbar surgery syndrome include epidural fibrosis, acquired stenosis, and facet joint pain among other causes. Even though fluoroscopically directed caudal epidural injections and facet joint interventions are effective in some patients, others continue to suffer with chronic persistent pain. Percutaneous adhesiolysis with target delivery of medications has been demonstrated to be effective in these patients. However, the evidence for percutaneous adhesiolysis in managing post surgery syndrome has been questioned, coupled with a paucity of controlled trials. STUDY DESIGN: A randomized, equivalence, controlled trial. SETTING: An interventional pain management practice, a specialty referral center, a private practice setting in the United States. OBJECTIVES: To evaluate the effectiveness of percutaneous epidural adhesiolysis in patients with chronic low back and lower extremity pain in post surgery syndrome and compare with fluoroscopically directed caudal epidural steroid injections. METHODS: Patients were randomly assigned to one of 2 groups: Group I (60 patients) receiving caudal epidural injections with catheterization up to S3 with local anesthetic, steroids, and 0.9% sodium chloride solution serving as the control group, and Group II (60 patients) receiving percutaneous adhesiolysis with targeted delivery of lidocaine, 10% hypertonic sodium chloride solution, and non-particulate Betamethasone serving as the intervention group. Randomization was performed by computer-generated random allocation sequence by simple randomization. OUTCOMES ASSESSMENT: Multiple outcome measures were utilized including the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3, 6, and 12 months post treatment. Significant pain relief was described as 50% or more, whereas significant improvement in the disability score was defined as a reduction of 40% or more. RESULTS: Significant pain relief ( > or= 50%) and functional status improvement was recorded in 73% of patients in Group II versus 12% in Group I (P < 0.001). The average procedures per year were 3.5 with an average total relief of 42 out of 52 weeks in Group II and 2.2 procedures with total relief per year of 13 weeks in Group I (P < 0.001). LIMITATIONS: The results of this study are limited by potentially inadequate double blinding, by the lack of a placebo group, and the preliminary report of one-year follow-up. CONCLUSIONS: Percutaneous adhesiolysis in chronic function-limiting, recalcitrant low back pain in post lumbar surgery syndrome demonstrated effectiveness in 73% of the patients.

Transforaminal lumbar interbody fusion for failed Graf ligamentoplasty: a report of two cases.
Author(s): Nagano, A; Miyamoto, K; Nishimoto, H; Hosoe, H; Suzuki, N; Shimizu, K
Journal: J Orthop Surg (Hong Kong) 2010 Feb 27; Vol. 17, Issue 2; Page(s) 220-2
[Medline ID - 19721157]

We report 2 cases of transforaminal lumbar interbody fusion for failed Graf ligamentoplasty. Both patients had residual or recurrent low back pain and leg pain after Graf ligamentoplasty, caused by lumbar segmental instability or narrowing of their intervertebral foramens. The pain improved markedly after the revision surgery. We recommend transforaminal lumbar interbody fusion for failed Graf ligamentoplasty, as it provides rigid interbody bony fusion and obviates complete exposure of the dural sac or dural tube.

Transitional lumbosacral vertebrae and low back pain: diagnostic pitfalls and management of Bertolotti's syndrome.
Author(s): Almeida, DB; Mattei, TA; S; ória, MG; Prandini, MN; Leal, AG; Milano, JB; Ramina, R
Journal: Arq Neuropsiquiatr 2010 Apr 7; Vol. 67, Issue 2A; Page(s) 268-72
[Medline ID - 19547821]

OBJECTIVE: Bertolotti's syndrome is a spine disorder characterized by the occurrence of a congenital lumbar transverse mega-apophysis in a transitional vertebral body that usually articulates with the sacrum or the iliac bone. It has been considered a possible cause of low back pain. METHOD: We analyzed the cases of Bertolotti's syndrome that failed clinical treatment and reviewed the literature concerning this subject. RESULTS: Five patients in our series had severe low back pain due to the neo-articulation and two of them were successfully submitted to surgical resection of the transverse mega-apophysis. Taking into account the clinical and surgical experience acquired with these cases, we propose a diagnostic-therapeutic algorithm. CONCLUSION: There is still no consensus about the most appropriate therapy for Bertolotti's syndrome. In patients in whom the mega-apophysis itself may be the source of back pain, surgical resection may be a safe and effective procedure.

Monoradiculopathy and secondary segmental instability caused by postoperative pars interarticularis fracture: a case report.
Author(s): Kaner, T; Tutkan, I
Journal: Turk Neurosurg 2009 Aug 15; Vol. 19, Issue 2; Page(s) 177-81
[Medline ID - 19431131]

Instability can develop after lumbar spinal surgery. What is also known as secondary segmental instability is one of the important causes of failed back syndrome. In this paper, we described a 45-year-old female patient who was diagnosed with secondary segmental instability caused by left L3 pars interarticularis fracture after a high lumbar disc surgery and was subsequently treated with re-operation. We evaluated the clinical course, diagnosis, and treatment methods for secondary segmental instability caused by postoperative pars interarticularis fracture. Furthermore, we emphasized the importance of preserving the pars interarticularis during upper lumbar disc surgeries in order to avoid a potential stress fracture.

Cell types obtained from the epidural space of patients with low back pain/radiculopathy.
Author(s): Heavner, JE; Bosscher, HA; Wachtel, MS
Journal: Pain Pract 2009 Jul 18; Vol. 9, Issue 3; Page(s) 167-72
[Medline ID - 19400818]

BACKGROUND: We investigated if correlations exist between medical history, tissue abnormalities, and cell types retrieved from the epidural space of patients with chronic low back pain (LBP) and chronic radicular pain (RP). METHODS: Approval was obtained from the Institutional Review Board for the Protection of Human Subjects to study 191 patients undergoing epiduroscopy. Visual inspection was performed and abnormal areas were identified. A specimen obtained from the area using a cytology brush was processed by the Thin Prep technique. Patients were divided into four groups based on the presence or absence and intensity of LBP and RP. The gender and age of the patients were recorded, as was any history of prior back surgery. Areas of tissue abnormalities were rated according to changes in vascularity and amount of fat, fibrosis, and inflammation. Stenosis was assessed from magnetic resonance imaging or computerized tomography scan images. Cytologic assessments included notations of the presence or absence of erythrocytes, leukocytes, cell groups, lipocytes, spindled cells, and large round cells. RESULTS: There was a significant difference in the number of patients from whom big round cells were obtained who had a high degree of LBP compared with the number of patients who had a high degree of both LBP and RP. CONCLUSIONS: The findings provide a foundation for future studies of cells obtained from similar patients with the goal of furthering the understanding of the pathogenesis of LBP/RP.

Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline.
Author(s): Chou, R; Atlas, SJ; Stanos, SP; Rosenquist, RW
Journal: Spine (Phila Pa 1976) 2009 Jul 16; Vol. 34, Issue 10; Page(s) 1078-93
[Medline ID - 20357643]

STUDY DESIGN: Systematic review. OBJECTIVE: To systematically assess benefits and harms of nonsurgical interventional therapies for low back and radicular pain. SUMMARY OF BACKGROUND DATA: Although use of certain interventional therapies is common or increasing, there is also uncertainty or controversy about their efficacy. METHODS: Electronic database searches on Ovid MEDLINE and the Cochrane databases were conducted through July 2008 to identify randomized controlled trials and systematic reviews of local injections, botulinum toxin injection, prolotherapy, epidural steroid injection, facet joint injection, therapeutic medial branch block, sacroiliac joint injection, intradiscal steroid injection, chemonucleo lysis, radiofrequency denervation, intradiscal electrothermal therapy, percutaneous intradiscal radiofrequency thermocoagulation, Coblation nucleoplasty, and spinal cord stimulation. All relevant studies were methodologically assessed by 2 independent reviewers using criteria developed by the Cochrane Back Review Group (for trials) and by Oxman (for systematic reviews). A qualitative synthesis of results was performed using methods adapted from the US Preventive Services Task Force. RESULTS: For sciatica or prolapsed lumbar disc with radiculopathy, we found good evidence that chemonucleolysis is moderately superior to placebo injection but inferior to surgery, and fair evidence that epidural steroid injection is moderately effective for short-term (but not long-term) symptom relief. We found fair evidence that spinal cord stimulation is moderately effective for failed back surgery syndrome with persistent radiculopathy, though device-related complications are common. We found good or fair evidence that prolotherapy, facet joint injection, intradiscal steroid injection, and percutaneous intradiscal radiofrequency thermocoagulation are not effective. Insufficient evidence exists to reliably evaluate other interventional therapies. CONCLUSION: Few nonsurgical interventional therapies for low back pain have been shown to be effective in randomized, placebo-controlled trials.

Effectiveness of spinal endoscopic adhesiolysis in post lumbar surgery syndrome: a systematic review.
Author(s): Hayek, SM; Helm, S; Benyamin, RM; Singh, V; Bryce, DA; Smith, HS
Journal: Pain Physician 2009 Jul 25; Vol. 12, Issue 2; Page(s) 419-35
[Medline ID - 19305488]

BACKGROUND: Post lumbar surgery syndrome with persistent chronic low back and lower extremity pain is common in the United States. Epidural fibrosis may account for as much as 20% to 36% of all cases of failed back surgery syndrome (FBSS). Percutaneous adhesiolysis with a catheter or direct visualization of the spinal canal and the contents with an endoscope are techniques employed in resistant cases when patients fail to respond to conservative modalities of treatment, including fluoroscopically directed epidural injections. Some patients failing to respond to percutaneous adhesiolysis are candidates for spinal endoscopic adhesiolysis. However, literature evaluating the effectiveness of spinal endoscopic adhesiolysis is sparse and discussions continue about its effectiveness, utility, and complications. STUDY DESIGN: A systematic review of the available literature. OBJECTIVE: To evaluate the effectiveness and safety of spinal endoscopic adhesiolysis in the management of chronic low back and lower extremity pain in post surgical patients with chronic recalcitrant pain, non-responsive to conservative modalities of management and fluoroscopically directed epidural injections. METHODS: A search of relevant resources (PubMed, EMBASE, and the Cochrane database) was accomplished and the resulting publications were examined based on the inclusion/exclusion criteria set forth. Randomized controlled trials and observational studies were included in the search. Two reviewers assessed the studies' methodologies and outcomes. Randomized clinical trials were assessed and scored based on the criteria established by the Cochrane methodological assessment criteria of randomized clinical trials and the observational studies were assessed and scored based on the Agency for Healthcare Research and Quality (AHRQ) criteria. Clinical relevance was evaluated utilizing Cochrane review criteria. Analysis was conducted using 5 levels of evidence, ranging from Level I to III, with 3 subcategories in Level II. OUTCOME MEASURES: The primary outcome measure was pain relief ( > or = 50%) in follow-up for at least 6 months. Pain relief for longer than 6 months was considered long-term and 6 months or less was considered short-term. The secondary outcome measures were functional and psychological status, return to work, patient satisfaction, and opioid intake. RESULTS: Of the 13 studies considered for inclusion, one randomized trial and 5 observational studies met inclu sion criteria for evidence synthesis based on the inclusion criteria and methodologic quality scores of 50 or more. The indicated level of evidence for endoscopic adhesiolysis is Level II-1 or II-2 evidence for short- and long-term relief based on the U.S. Preventive Services Task Force (USPSTF) criteria. LIMITATIONS: There was a paucity of literature for randomized trials. CONCLUSION: Spinal endoscopic adhesiolysis may be used as an effective treatment modality for chronic refractory low back pain and radiculopathy that is related to epidural adhesions.

Systematic review of percutaneous adhesiolysis and management of chronic low back pain in post lumbar surgery syndrome.
Author(s): Epter, RS; Helm, S; Hayek, SM; Benyamin, RM; Smith, HS; Abdi, S
Journal: Pain Physician 2009 Jul 25; Vol. 12, Issue 2; Page(s) 361-78
[Medline ID - 19305485]

BACKGROUND: Post lumbar surgery syndrome or failed back surgery syndrome with persistent pain continues to increase over the years. The speculated causes of post lumbar laminectomy syndrome include acquired stenosis, epidural fibrosis, arachnoiditis, radiculopathy, and recurrent disc herniation. Epidural fibrosis may account for as much as 20% to 36% of all cases of failed back surgery syndrome. Percutaneous epidural adhesiolysis has been employed in interventional pain management in the treatment of chronic, refractory low back and lower extremity pain after back surgery. STUDY DESIGN: A systematic review of randomized trials and observational studies. OBJECTIVE: To evaluate the effectiveness of percutaneous adhesiolysis in managing chronic low back and lower extremity pain due to post lumbar surgery syndrome. METHODS: A comprehensive literature search was conducted utilizing electronic databases, as well as systematic reviews and cross references from 1966 through December 2008. The quality of individual articles used in this analysis was assessed by modified Cochrane review criteria for randomized trials and the Agency for Healthcare Research and Quality (AHRQ) criteria for assessment of observational studies. Clinical relevance was evaluated using 5 questions according to the criteria recommended by the Cochrane Review Back Group. Analysis was conducted using 5 levels of evidence, ranging from Level I to III, with 3 subcategories in Level II. OUTCOME PARAMETERS: The primary outcome measure was pain relief (short-term relief of at least 6 months and long-term relief of more than 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and change in opioid intake. RESULTS: Of the 13 studies considered for inclusion, 3 randomized trials and 4 observational studies met the inclusion criteria for methodologic quality assessment and evidence synthesis based on methodologic quality scores of 50 or more. Evidence of percutaneous adhesiolysis in the management of chronic low back pain in post-lumbar surgery syndrome is Level I to Level II-1, with evidence derived from 3 randomized trials. LIMITATIONS: There is a paucity of efficacy and pragmatic trials. No trials have been published after 2006. CONCLUSION: The indicated level of evidence for percutaneous adhesiolysis is Level I or II-1 based on the US Preventative Services Task Force (USPSTF) criteria.

[Clinical study of transforaminal instrumented lumbar interbody fusion]
Author(s): Cao, ZL; Chen, XW; Wu, ZH
Journal: Zhongguo Gu Shang 2009 Apr 2; Vol. 22, Issue 2; Page(s) 133-5
[Medline ID - 19281028]

OBJECTIVE: To study the effect and complications of transforaminal lumbar interbody fusion technique. METHODS: The medical records and radiographs of 40 patients undergone transforaminal lumbar interbody fusion between 2005 and 2007 were retrospectively reviewed. There were 49 segments with fusion. Preoperative and 1 year postoperative functional evaluation were graded with ODI and VAS scoring system. The height and angle of the intervertebral space and the fusion status were measured as well. RESULTS: All patients were followed-up for 12 to 24 months with the average of 18 mouths. There were no severity postoperative complications. The operation time averaged 160 min and average blood loss 510 ml. The effect results were excellent in 28 cases, good in 7 and fair in 5. The fusion rate was 100%. One year after operation, the pain relief in the VAS and the reduction of the ODI were significant (P < 0.01), the height and angle of the intervertebral space increased obviously (P < 0.05). Fifteen patients complained low back pain to some extent untill the last follow-up. CONCLUSION: Transforaminal lumbar interbody fusion can achieve satisfactory clinical and radiographic results especially for the failed back surgery syndrome.
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