Minimally Invasive Procedures for the Treatment of Failed Back Surgery Syndrome

Mavrocordatos, Philippe; Cahana, Alex

doi:10.1007/3-211-32234-5_5

Cited by 14 publications

(7 citation statements)

References 94 publications

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“…The literature suggests many treatment modalities in FBSS. 27 , 28 The literature seems to suggest that after transforaminal endoscopic surgery 69–83% of the patients experience a satisfactory outcome. 29 In our hands, because we subspecialize in endoscopic foraminal surgery, our experience allows for a success rate of 26/30, or 87%.…”

Section: Complications: Avoidance Of Irritation Of the Drgmentioning

confidence: 99%

Endoscopic Foraminal Decompression for Failed Back Surgery Syndrome under local Anesthesia

Yeung

Gore²

2014

Int J Spine Surg

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BackgroundThe most common causes of failed back surgery are residual or recurrent herniation, foraminal fibrosis and foraminal stenosis that is ignored, untreated, or undertreated. Residual back ache may also be from facetal causes or denervation and scarring of the paraspinal muscles.1–6 The original surgeon may advise his patient that nothing more can be done on the basis of his opinion that the nerve was visually decompressed by the original surgery, supported by improved post-op imaging and follow-up studies such as EMG and conduction velocity studies. Post-op imaging or electrophysiological assessment may be inadequate to explain all the reasons for residual or recurrent symptoms. Treatment of Failed back surgery by repeat traditional open revision surgery usually incorporates more extensive decompression causing increased instability and back pain, therefore necessitating fusion. The authors, having limited their practice to endoscopic MIS surgery over the last 15-20 years, report on their experience gained during that period to relieve pain by endoscopically visualizing and treating unrecognized causative patho-anatomy in FBSS.7MethodsThirty consecutive patients with FBSS presenting with back and leg pain that had supporting imaging diagnosis of lateral stenosis and /or residual / recurrent disc herniation, or whose pain complaint was supported by relief from diagnostic and therapeutic injections (Figure 1), were offered percutaneous transforaminal endoscopic discectomy and foraminoplasty over a repeat open procedure. Each patient sought consultation following a transient successful, partially successful or unsuccessful open translaminar surgical treatment for disc herniation or spinal stenosis. Endoscopic foraminoplasty was also performed to either decompress the bony foramen for foraminal stenosis, or foraminoplasty to allow for endoscopic visual examination of the affected traversing and exiting nerve roots in the axilla, also known as the “hidden zone” of Macnab (Figure 2).8, 9 The average follow up time was, average 40 months, minimum 12 months. Outcome data at each visit included Macnab, VAS and ODI.Fig. 1A diagnostic and therapeutic epidural gram may help identify unrecognized lateral recess stenosis underestimated by MRI. An excellent result from a therapeutic block lends excellent prognosis for a more lasting and “permanent” result from transforaminal endoscopic lateral recess decompression.Fig. 2Kambin's Triangle provides access to the “hidden zone” of Macnab by foraminoplasty. The foramen and lateral recess is decompressed by removing the ventral aspect and tip of the superior articular process to gain access to the axilla between the traversing and exiting nerve. FBSS contains patho-anatomy in the axilla between the traversing and exiting nerve that hides the pain generators of FBSS.ResultsThe average pre-operative VAS improved from 7.2 to 4.0, and ODI 48% to 31%. While temporary dysesthesia occurred in 4 patients in the early post-operative period, all were happy, as all received additional re...

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Section: Complications: Avoidance Of Irritation Of the Drgmentioning

confidence: 99%

Endoscopic Foraminal Decompression for Failed Back Surgery Syndrome under local Anesthesia

Yeung

Gore²

2014

Int J Spine Surg

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“…), alone or in association with spinal epidural steroid injections. [1][2][3][4][5] Only a few complications of this technique are described in the literature. 6,7 We report on a patient who was treated for a herniated lumbar disc with oxygen-ozone therapy and, thereafter, developed a fatal septic complication.…”

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confidence: 99%

Fulminating Septicemia Secondary to Oxygen-Ozone Therapy for Lumbar Disc Herniation

Gazzeri

Galarza

Neroni

et al. 2007

Spine

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“…Failed back surgery syndrome remains difficult to treat successfully not only because of the lack of a precise pathophysiology and complexity of its clinical presentation [4, 6–10] but also because of the lack of a gold standard therapy or one-size-fits-all solution [11] and the limited availability of clinical guidance [12]. There is a consensus in the literature, as well as among members of the CBLP Network, that patients with FBSS are at risk of being confined to the care of a single discipline and that differences in treatment recommendations are often determined by the managing healthcare provider's experience and discipline [3, 13, 23].…”

Section: Discussionmentioning

confidence: 99%

Optimizing the Management and Outcomes of Failed Back Surgery Syndrome: A Proposal of a Standardized Multidisciplinary Team Care Pathway

Gatzinsky

Eldabe

Deneuville

et al. 2019

Pain Research and Management

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Failed back surgery syndrome (FBSS) is a major, worldwide health problem that generates considerable expense for healthcare systems. A number of controversial issues concerning the management of FBSS are regularly debated, but no clear consensus has been reached. This pitfall is the result of lack of a standardized care pathway due to insufficient characterization of underlying pathophysiological mechanisms, which are essential to identify in order to offer appropriate treatment, and the paucity of evidence of treatment outcomes. In an attempt to address the challenges and barriers in the clinical management of FBSS, an international panel of physicians with a special interest in FBSS established the Chronic Back and Leg Pain (CBLP) Network with the primary intention to provide recommendations through consensus on how to optimize outcomes. In the first of a series of two papers, a definition of FBSS was delineated with specification of criteria for patient assessment and identification of appropriate evaluation tools in order to choose the right treatment options. In this second paper, we present a proposal of a standardized care pathway aiming to guide clinicians in their decision-making on how to optimize their management of FBSS patients. The utilization of a multidisciplinary approach is emphasized to ensure that care is provided in a uniform manner to reduce variation in practice and improve patient outcomes.

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Minimally Invasive Procedures for the Treatment of Failed Back Surgery Syndrome

Cited by 14 publications

References 94 publications

Endoscopic Foraminal Decompression for Failed Back Surgery Syndrome under local Anesthesia

Endoscopic Foraminal Decompression for Failed Back Surgery Syndrome under local Anesthesia

Fulminating Septicemia Secondary to Oxygen-Ozone Therapy for Lumbar Disc Herniation

Optimizing the Management and Outcomes of Failed Back Surgery Syndrome: A Proposal of a Standardized Multidisciplinary Team Care Pathway

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