Failed Back Syndrome

Onesti, Stephen T.

doi:10.1097/01.nrl.0000138733.09406.39

Cited by 78 publications

(54 citation statements)

References 13 publications

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“…19 Patients who undergo reoperation frequently present with FBSS, a heterogeneous disorder characterized by chronic and debilitating pain following lumbar spine surgery. 24,26 Revision fusion in these patients may allow for improved decompression, restoration of sagittal balance and lordosis, stabilization of instrumentation, and arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing 2-year health care costs in patients undergoing revision lumbar fusion procedures

Parker

Shau²,

Mendenhall³

et al. 2012

SPI

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Object Revision lumbar fusion procedures are technically challenging and can be associated with tremendous health care resource utilization and cost. There is a paucity of data regarding specific factors that significantly contribute to increased cost of care. In light of this, the authors set out to identify independent risk factors predictive of increasing 2-year direct health care costs after revision lumbar fusion. Methods One hundred fifty patients undergoing revision instrument-assisted fusion for adjacent-segment disease (50 cases), pseudarthrosis (47 cases), or same-level stenosis (53 cases) were included in this study. Patient demographics, comorbidities, preoperative health states as assessed by patient-reported outcome questionnaires and perioperative complications were collected and analyzed. Two-year back-related medical resource utilization and direct health care costs were assessed. The independent association of all variables to increasing cost was assessed using multivariate linear regression analysis. Results There was a wide range ($24,935–$63,769) in overall 2-year direct costs for patients undergoing revision lumbar fusion (mean $32,915 ± $8344 [± SD]). Preoperative variables independently associated with 2-year direct health care costs included diagnosis of congestive heart failure, more severe leg pain (visual analog scale), greater back-related disability (Oswestry Disability Index), and worse mental health (12-Item Short Form Health Survey Mental Component Summary score). There was a 1.1- to 1.2-fold increase in cost for patients in the greatest quartiles compared with those in the lowest quartiles for these variables. Surgical site infection, return to the operating room, and spine-related hospital readmission during the 90-day global health period were postoperative variables independently associated with 2-year cost. Patients in the greatest versus lowest quartiles had a 1.7- to 1.9-fold increase in cost for these variables. Conclusions Revision lumbar fusion can be associated with considerable 2-year health care costs. These costs can also vary widely among patients, as evidenced by the 2.6-fold overall cost range in this series. Although comorbidities and preoperative severity of disease states contribute to cost of care, the primary drivers of increased cost include perioperative complications such as surgical site infection, return to the operating room, and readmission during the global health period. Measures focused on health service improvement will be most successful in reducing the cost of care for patients undergoing revision lumbar fusion.

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Section: Discussionmentioning

confidence: 99%

Factors influencing 2-year health care costs in patients undergoing revision lumbar fusion procedures

Parker

Shau²,

Mendenhall³

et al. 2012

SPI

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“…Spinous processes, supraspinal and interspinal ligaments are all resected for decompression, severely compromising the architecture of the spinal posterior column. The paraspinal muscles are physiologically abnormal following operation due to scar healing and denervation, [24] and there is evidence that both the resection and the changes in the paraspinal muscles may lead to decreased trunk muscle strength, [12,16] late onset of spinal instability, [21] and potentially to severe back pain or ''failed back syndrome'' [18,24].…”

Section: Introductionmentioning

confidence: 99%

Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach

et al. 2009

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We set out to determine whether a minimally invasive approach for one-level instrumented posterior lumbar interbody fusion reduced undesirable changes in the multifidus muscle, compared to a conventional open approach. We also investigated associations between muscle injury during surgery (creatinine kinase levels), clinical outcome and changes in the multifidus at followup. We studied 59 patients treated by one team of surgeons at a single institution (minimally invasive approach in 28 and conventional open approach in 31, voluntarily chosen by patients). More than 1 year postoperatively, all the patients were followed up with the visual analogue scale (VAS) and Oswestry disability index (ODI), and 16 patients from each group were evaluated using MRI. This enabled the cross-sectional area (CSA) of lean multifidus muscle, and the T2 signal intensity ratio of multifidus to psoas muscle, to be compared at the operative and adjacent levels. The minimally invasive group had less postoperative back pain (P \ 0.001) and lower postoperative ODI scores (P = 0.001). Multifidus atrophy was less in the minimally invasive group (P \ 0.001), with mean reductions in CSA of 12.2% at the operative and 8.5% at the adjacent levels, compared to 36.8% and 29.3% in the conventional open group. The increase in the multifidus:psoas T2 signal intensity ratio was similarly less marked in the minimally invasive group where values increased by 10.6% at the operative and 8.3% at the adjacent levels, compared to 34.4 and 22.7% in the conventional open group (P \ 0.001). These changes in multifidus CSA and T2 signal intensity ratio were significantly correlated with postoperative creatinine kinase levels, VAS scores and ODI scores (P \ 0.01). The minimally invasive approach caused less change in multifidus, less postoperative back pain and functional disability than conventional open approach. Muscle damage during surgery was significantly correlated with long-term multifidus muscle atrophy and fatty infiltration. Furthermore these degenerative changes of multifidus were also significantly correlated with long-term clinical outcome.

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“…Bazı hastalarda narkotik ilaç tedavilerine de başvurulabilmektedir (20,21). Başarısız bel cerrahisi sendromunda vasküler yapı üzerinde oluşan disk baskısı sonucu gelişen hipoksi, operasyon esnasında yapılan manipülasyonlar, postoperatif instabiliteler sinir köklerinde yaralanmalara ve nö-ropatik ağrıya neden olmaktadır (20,22). Nöropatik ağrının farmakolojik tedavisinde ise gabapentin önemli bir yer tutmaktadır (23).…”

Section: Discussionunclassified

The Efficacy of Gabapentin in Patients with Failed Back Surgery Syndrome

Çakır¹,

Evcik²,

Subaşı³

et al. 2014

Turk J Phys Med Rehab

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Objective: Failed back syndrome is a common clinical syndrome that is seen after lumbar disc herniation operations. In this study, we planned to investigate the effects of gabapentin in the treatment of failed back syndrome. Material and Methods:The study included 47 patients who had been operated on because of LDH. They were divided into two groups. Group 1 (n=24) had been treated with gabapentin (300 mgr-3000 mgr/daily) and a lumbar exercise program, and Group 2 (n=23) received only the home exercise program. Patients were assessed by means of range of motion, Schober test, straight leg test, and pain and functional capacity. Pain was evaluated by visual analog scale and neuropathic pain scale. Functional capacity was assessed by Oswestry scale. Assessments were done before and after first and third month of the therapy. Results: The mean age of the patients was 48.7±12.3 (24-81) years. In Group 1, 16 patients (70%) had been operated on at the L4-L5 level, and in Group 2, 10 patients (44%) had been operated on at the L4-L5 level. There was a statistically significant improvement in Oswestry scale scores in Group 1 and Group 2 (p<0.05). There was a statistically significant improvement in neuropathic pain scale scores in Group 1 (p<0.05). However, no significant differences were found in neuropathic pain scale scores in Group 2 (p>0.05). Conclusion: Gabapentin treatment was found to be effective, especially for functional capacity and pain, in failed back syndrome patients. Key Words: Gabapentin, failed, back, efficacy Özet Amaç: Başarısız bel cerrahisi sendromu, lomber disk herniasyonu ameliyatlarından sonra yaygın görülen klinik bir sendromdur. Biz bu çalışmamızda lomber disk herniasyonu nedeniyle cerrahi tedavi olan ve başarısız bel cerrahisi sendromu tanısı konulan hastalarda gabapentin tedavisinin etkinliğini araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmaya lomber disk herniasyonu nedeni ile ameliyat olan 47 hasta alındı. Hastalar rastgele iki gruba ayrıldı. Birinci grup (n=24) günde 300-3000 mg gabapentin kullanan ve lomber egzersiz programı verilen hastalardan oluşuyordu; ikinci grup ise sadece egzersiz programı verilen kontrol grubuydu (n=23). Hastaların eklem hareket açıklığı, Schober ve düz bacak kaldırma testleri, ağrı ve fonksiyonel kapasitesi değerlendirildi. Ağrı; vizüel analog skala ve nöropatik ağrı skalası ile değerlendirildi. Fonksiyonel kapasite, Oswestry bel ağrısı anketi kullanılarak değerlendirildi. Değerlendirmeler tedavi öncesi, tedaviden bir ve üç ay sonra yapıldı. Bulgular: Hastaların yaş ortalaması 48,7±12,3 (24-81) idi. Grup 1'de 16 hasta (%70 ) ve Grup 2'de 10 hastanın (%44) L4-L5 disk herniasyonundan opere edildiği tespit edildi. Her iki grubun Oswestry skorlarında anlamlı düzelme vardı (p<0,05). Grup 1'de nöropatik ağrı skalası değerlerinde anlamlı düzelme tespit edildi (p<0,05) ancak Grup 2'de anlamlı düzelme saptanmadı (p>0,05). Sonuç: Gabapentinin başarısız bel cerrahisi sendromu tanısı olan hastalarda özellikle ağrı ve fonksiyonel kapasite üzerine olumlu etkileri m...

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Failed Back Syndrome

Abstract: Despite extensive work in recent years, FBS remains a challenging and costly disorder. Recent advances in surgical reconstruction, rehabilitation, and pain management technique offer hope for patients with this painful and disabling condition.

Cited by 78 publications

References 13 publications

Factors influencing 2-year health care costs in patients undergoing revision lumbar fusion procedures

Factors influencing 2-year health care costs in patients undergoing revision lumbar fusion procedures

Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach

The Efficacy of Gabapentin in Patients with Failed Back Surgery Syndrome

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