PRESENTATION AND MANAGEMENT OF FAILED BACK SURGERY SYNDROME BY STEERABLE EPIDURAL CATHETER

Authors

  • Anjam Ibrahim Sulaiman Dept. of Surgery, College of Medicine, Hawler Medical University, Kurdistan Region, Iraq.
  • Othman Ismat Abdulmajeed College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq.
  • Hoshanc Sdeeq Rashid Rozhawa Hospital, Erbil, Kurdistan Region, Iraq.

DOI:

https://doi.org/10.17656/jsmc.10313

Keywords:

FBSS, Epidural adhesiolysis, Oswestry Disability Index, Steerable epidural catheter, Chronic low back pain

Abstract

Background 

Failed back surgery syndrome (FBSS) is a frequently occurring disease following lumbar spinal surgery. It has also been named “post lumbar surgery syndrome,” and much research has been done. The patients share continued back and extremity pain following one or more spinal operations. It may be due to inadequate operations, operative complications, progression of degenerative processes, or a new pathology.

Objectives 

To successfully use a steerable epidural catheter to treat ‘Failed Back Surgery Syndrome’ patients. Study Design a case series was carried out on 50 patients with FBSS.

Methods

Clinical data were collected from patients with FBSS, pain symptoms, MRI findings. (VAS) the visual analog scale has been used for pain degree evaluation, (ODI) Oswestry disability index was used for functional improvement evaluation. Percutaneous adhesiolysis under fluoroscopy guide has been performed, and the patients were assessed at one month and three months intervals from the day of the procedure.

Results

In comparing to baseline values, there was a significant decrease of the mean and median VAS after one month and three months of the intervention (p < 0.001). The same is for the ODI%, where it is clear that its median decreased from 48% to 22% after one month (p < 0.001) and to 8% after three months (p < 0.001).

Conclusion

Steerable epidural catheter was effective in FBSS treatment with improvement in pain and function.

References

Chan CW, Peng P. Failed back surgery syndrome. Pain Med. 2011 Apr 1;12(4):577-606. DOI: https://doi.org/10.1111/j.1526-4637.2011.01089.x

Teixeira MJ, Yeng LT, Garcia OG, Fonoff ET, Paiva WS, Araujo JO. Failed back surgery pain syndrome: therapeutic approach descriptive study in 56 patients. Rev Assoc Med Bras (English Edition). 2011 May 1;57(3):282-7. DOI: https://doi.org/10.1016/S2255-4823(11)70060-1

Sebaaly A, Lahoud MJ, Rizkallah M, Kreichati G, Kharrat K. Etiology, evaluation, and treatment of failed back surgery syndrome. Asian Spine J. 2018 Jun;12(3):574. DOI: https://doi.org/10.4184/asj.2018.12.3.574

Baber Z, Erdek MA. Failed back surgery syndrome: current perspectives. J Pain Res. 2016;9:979. DOI: https://doi.org/10.2147/JPR.S92776

Wolfer LR, Derby R, Lee JE. Spine Injections for Persistent Lumbar and Radicular Pain After Lumbar Spine Surgery. In Advanced Concepts in Lumbar Degenerative Disk Disease. Springer, Berlin, Heidelberg. 2016 (p. 525-574). DOI: https://doi.org/10.1007/978-3-662-47756-4_38

Rigoard P, Gatzinsky K, Deneuville JP, Duyvendak W, Naiditch N, Van Buyten JP, Eldabe S. Optimizing the management and outcomes of failed back surgery syndrome: a consensus statement on definition and outlines for patient assessment. Pain Research and Management. 2019 Feb 18;2019. DOI: https://doi.org/10.1155/2019/3126464

Anderson SR, Racz GB, Heavner J. Evolution of epidural lysis of adhesions. Pain physician. 2000 Jul;3(3):262-70 DOI: https://doi.org/10.36076/ppj.2000/3/262

Manchikanti L, Singh V, Kloth D, Slipman CW, Jasper JF, Trescot AM, et al. Interventional techniques in the management of chronic pain: Part 2.0. Pain Physician. 2001 Jan;4(1):24-96. DOI: https://doi.org/10.36076/ppj.2001/4/24

Cooper RG, Freemont AJ, Hoyland JA, Jenkins JP, West CG, Illingworth KJ, et al. Herniated intervertebral disc-associated periradicular fibrosis and vascular abnormalities occur without inflammatory cell infiltration. Spine. 1995 Mar;20(5):591-8. DOI: https://doi.org/10.1097/00007632-199503010-00016

Heavner JE, Bosscher HA, Wachtel MS. cell types obtained from the epidural space of patients with low back pain/radiculopathy. Pain Prac. 2009 May;9(3):167-72. DOI: https://doi.org/10.1111/j.1533-2500.2009.00272.x

Kobayashi S, Baba H, Uchida K, Kokubo Y, Kubota C, Yamada S, et al. Effect of mechanical compression on the lumbar nerve root: localization and changes of intraradicular inflammatory cytokines, nitric oxide, and cyclooxygenase. Spine. 2005 Aug 1;30(15):1699-705. DOI: https://doi.org/10.1097/01.brs.0000171910.97937.0e

Ng L, Chaudhary N, Sell P. The efficacy of corticosteroids in periradicular infiltration for chronic radicular pain: a randomized, double-blind, controlled trial. Spine. 2005 Apr 15;30(8):857-62. DOI: https://doi.org/10.1097/01.brs.0000158878.93445.a0

Parr AT, Diwan S, Abdi S. Lumbar interlaminar epidural injections in managing chronic low back and lower extremity pain: A systematic review. Pain Physician. 2009;12(1):163-88. DOI: https://doi.org/10.36076/ppj.2009/12/163

Vad VB, Bhat AL, Lutz GE, Cammisa F. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine. 2002 Jan 1;27(1):11-5. DOI: https://doi.org/10.1097/00007632-200201010-00005

Rosenberg SK, Grabinsky A, Kooser C, Boswell MV. Effectiveness of transforaminal epidural steroid injections in low back pain: A one-year experience. Pain Physician 2002; 5:266-270 DOI: https://doi.org/10.36076/ppj.2002/5/266

Manchikanti L, Singh V, Cash KA, Pampati V. Preliminary results of a randomized, equivalence trial of fluoroscopic caudal epidural injections in managing chronic low back pain: Part 3--Post-surgery syndrome. Pain physician. 2008;11(6):817-31. DOI: https://doi.org/10.36076/ppj.2008/11/817

Niagara WI. Management of pain of post lumbar surgery syndrome: one-year results of a randomized, double-blind, active-controlled trial of fluoroscopic caudal epidural injections. Pain Physician. 2010 Nov;13(1):509-21.

Manchikanti L. Interventional Pain Physician. Pain physician. 2000;3(2):132-8. DOI: https://doi.org/10.36076/ppj.2000/3/132

Chopra P, Smith HS, Deer TR, Bowman RC. Role of adhesiolysis in the management of chronic spinal pain: A systematic review of effectiveness and complications. Pain Physician. 2005;8(1):87-100. DOI: https://doi.org/10.36076/ppj.2006/9/87

Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomized controlled trial in patients with failed back surgery syndrome. Pain. 2007;132(1-2):179-88. DOI: https://doi.org/10.1016/j.pain.2007.07.028

Chou R, Huffman LH. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007 Oct 2;147(7):505-14 DOI: https://doi.org/10.7326/0003-4819-147-7-200710020-00008

Chun-jing H, Hao-Xiong N. The application of percutaneous lysis of epidural adhesions in patients with failed back surgery syndrome. Acta Cir Bras. 2012;27(4):357-62. DOI: https://doi.org/10.1590/S0102-86502012000400013

Vidyasagar KY, Manchikanti L. A comparative effectiveness evaluation of percutaneous adhesiolysis and epidural steroid injections in managing lumbar post-surgery syndrome: A randomized, equivalence controlled trial. Pain Physician. 2009 Nov;12:E355-68. DOI: https://doi.org/10.36076/ppj.2009/12/E355

Epter RS, Helm S, Hayek SM, Benyamin RM, Smith HS, Abdi S. Systematic review of percutaneous adhesiolysis and management of chronic low back pain in post lumbar surgery syndrome. Pain physician. 2009 Mar 1;12(2):361-78. DOI: https://doi.org/10.36076/ppj.2009/12/361

Manchikanti L, Singh V, Cash KA, Pampati V. Assessment of the effectiveness of percutaneous adhesiolysis and caudal epidural injections in managing post lumbar surgery syndrome: 2-year follow-up of a randomized, controlled trial. J Pain Res. 2012;5:597. DOI: https://doi.org/10.2147/JPR.S38999

Lee JH, Lee SH. Clinical effectiveness of percutaneous adhesiolysis versus transforaminal epidural steroid injection in patients with post lumbar surgery syndrome. Reg Anesth Pain Med. 2014;39(3):214-8. DOI: https://doi.org/10.1097/AAP.0000000000000073

Cho JH, Lee JH, Song KS, Hong JY, Joo YS, Lee DH, et al. Treatment outcomes for patients with failed back surgery. Pain Physician. 2017;20(1): E29-43. DOI: https://doi.org/10.36076/ppj.2017.1.E29

Veihelmann A, Devens C, Trouillier H, Birkenmaier C, Gerdesmeyer L, Refior HJ. Epidural neuroplasty versus physiotherapy to relieve pain in patients with sciatica: a prospective randomized, blinded clinical trial. J Orthop Sci. 2006 Jul 1;11(4):365-9. DOI: https://doi.org/10.1007/s00776-006-1032-y

Beyer CD, Damron KS. Role of one-day epidural adhesiolysis in management of chronic low back pain: A randomized clinical trial. Pain physician. 2001;4(2):153-66. DOI: https://doi.org/10.36076/ppj.2001/4/153

Jamison DE, Hsu E, Cohen SP. Epidural adhesiolysis: an evidence-based review. J Neurosurg Sci. 2014;58(2):65-76.

Published

2021-09-21

How to Cite

1.
Sulaiman A, Abdulmajeed O, Rashid H. PRESENTATION AND MANAGEMENT OF FAILED BACK SURGERY SYNDROME BY STEERABLE EPIDURAL CATHETER. JSMC [Internet]. 2021 Sep. 21 [cited 2024 Jul. 3];11(3):289-96. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10313

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