Managing Chronic Pain of Spinal Origin After Lumbar Surgery

Phillips, Frank M.; Cunningham, Benjamin; Wetzel, F. Todd; Prager, Joshua P.; Saal, Jeffrey A.; Slosar, Paul; Straus, Barry; Turk, Dennis C.; Andersson, Gunnar; Weinstein, James Neil

doi:10.1097/00007632-200211150-00029

Cited by 26 publications

(26 citation statements)

References 40 publications

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“…Data suggest that chronic back and leg pain after spinal surgery should be treated nonoperatively unless progressive neurologic deficits exist. 22 A recent review reported that approximately 1 in 5 patients who have undergone various surgeries (orthopaedic, abdominal, major gynecological, or thoracic) experience severe postoperative pain, or only poor to fair pain relief despite pain management therapies. 19 Certain physical therapy treatments (pelvic floor muscle training, bladder training, and weighted vaginal cones) have been shown to offer some therapeutic benefit in mixed urinary incontinence in women.…”

Section: Review Of the Evidencementioning

confidence: 99%

Chiropractic High-Velocity Low-Amplitude Spinal Manipulation in the Treatment of a Case of Postsurgical Chronic Cauda Equina Syndrome

Lisi¹,

Bhardwaj²

2004

Journal of Manipulative and Physiological Therapeutics

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Section: Review Of the Evidencementioning

confidence: 99%

Chiropractic High-Velocity Low-Amplitude Spinal Manipulation in the Treatment of a Case of Postsurgical Chronic Cauda Equina Syndrome

Lisi¹,

Bhardwaj²

2004

Journal of Manipulative and Physiological Therapeutics

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“…Increased complication rates have been reported with revision spine surgery with increased occurrence of dural tears, nerve root injury, and bleeding [14,15]. Phillips and Cunningham [16] reported that no form of surgical treatment or adhesion lysis procedure was safe or effective for post-lumbar laminectomy syndrome.…”

Section: Introductionmentioning

confidence: 99%

A randomized, controlled trial of spinal endoscopic adhesiolysis in chronic refractory low back and lower extremity pain [ISRCTN 16558617]

et al. 2005

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BackgroundPostoperative epidural fibrosis may contribute to between 5% to 60% of the poor surgical outcomes following decompressive surgery. Correlations have been reported between epidural scarring and radicular pain, poor surgical outcomes, and a lack of any form of surgical treatment. The use of spinal endoscopic adhesiolysis in recent years in the management of chronic refractory low back and lower extremity pain has been described.MethodsA prospective, randomized, double-blind trial was conducted to determine the outcome of spinal endoscopic adhesiolysis to reduce pain and improve function and psychological status in patients with chronic refractory low back and lower extremity pain. A total of 83 patients were evaluated, with 33 patients in Group I and 50 patients in Group II. Group I served as the control, with endoscopy into the sacral level without adhesiolysis, followed by injection of local anesthetic and steroid. Group II received spinal endoscopic adhesiolysis, followed by injection of local anesthetic and steroid.ResultsAmong the 50 patients in the treatment group receiving spinal endoscopic adhesiolysis, significant improvement without adverse effects was shown in 80% at 3 months, 56% at 6 months, and 48% at 12 months. The control group showed improvement in 33% of the patients at one month and none thereafter. Based on the definition that less than 6 months of relief is considered short-term and longer than 6 months of relief is considered long-term, a significant number of patients obtained long-term relief with improvement in pain, functional status, and psychological status.ConclusionSpinal endoscopic adhesiolysis with targeted delivery of local anesthetic and steroid is an effective treatment in a significant number of patients with chronic low back and lower extremity pain without major adverse effects.

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“…9 Furthermore, assessing symptomatic but nonprogressive deformity can be difficult, 10 as is separating symptoms due to deformity from those due to claudication. 11 Hence, the mere presence of a deformity on examination or on radiograph should not focus all attention on the deformity. It is important to remember that painproducing pathology is frequently identified in areas that would not have been included in the fusion according to accepted rules for treating idiopathic scoliosis.…”

Section: Discussionmentioning

confidence: 99%

Considerations for Focused Surgical Intervention in the Presence of Adult Spinal Deformity

Weidenbaum

2006

Spine

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This brief and limited communication reviews some of the pertinent issues and provides several examples of selective surgical treatment options without curve arthrodesis in patients with deformity. These options are typically much smaller surgical undertakings, particularly in adult patients who generally have complicating comorbidities. Little has been published to guide surgical management for these conditions.

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Managing Chronic Pain of Spinal Origin After Lumbar Surgery

Cited by 26 publications

References 40 publications

Chiropractic High-Velocity Low-Amplitude Spinal Manipulation in the Treatment of a Case of Postsurgical Chronic Cauda Equina Syndrome

Chiropractic High-Velocity Low-Amplitude Spinal Manipulation in the Treatment of a Case of Postsurgical Chronic Cauda Equina Syndrome

A randomized, controlled trial of spinal endoscopic adhesiolysis in chronic refractory low back and lower extremity pain [ISRCTN 16558617]

Considerations for Focused Surgical Intervention in the Presence of Adult Spinal Deformity

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