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Yoon JP, Son HS, Lee J, Byeon GJ. Multimodal management strategies for chronic pain after spinal surgery: a comprehensive review. Anesth Pain Med (Seoul) 2024; 19:12-23. [PMID: 38311351 PMCID: PMC10847004 DOI: 10.17085/apm.23122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/18/2023] [Accepted: 01/01/2024] [Indexed: 02/08/2024] Open
Abstract
"Chronic pain after spinal surgery" (CPSS) is a nonspecific term for cases in which the end result of surgery generally does not meet the preoperative expectations of the patient and surgeon. This term has replaced the previous term i.e., failed back surgery syndrome. CPSS is challenging for both patients and doctors. Despite advancements in surgical techniques and technologies, a subset of patients continue to experience persistent or recurrent pain postoperatively. This review provides an overview of the multimodal management for CPSS, ranging from conservative management to revision surgery. Drawing on recent research and clinical experience, we aimed to offer insights into the diverse strategies available to improve the quality of life of CPSS patients.
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Affiliation(s)
- Jung-Pil Yoon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hong-Sik Son
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jimin Lee
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Gyeong-Jo Byeon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Miękisiak G. Failed Back Surgery Syndrome: No Longer a Surgeon's Defeat-A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1255. [PMID: 37512066 PMCID: PMC10384667 DOI: 10.3390/medicina59071255] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/25/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
The introduction of the term Persistent Spinal Pain Syndrome (PSPS-T1/2), replacing the older term Failed Back Surgery Syndrome (FBSS), has significantly influenced our approach to diagnosing and treating post-surgical spinal pain. This comprehensive review discusses this change and its effects on patient care. Various diagnostic methods are employed to elucidate the underlying causes of back pain, and this information is critical in guiding treatment decisions. The management of PSPS-T1/2 involves both causative treatments, which directly address the root cause of pain, and symptomatic treatments, which focus on managing the symptoms of pain and improving overall function. The importance of a multidisciplinary and holistic approach is emphasized in the treatment of PSPS-T1/2. This approach is patient-centered and treatment plans are customized to individual patient needs and circumstances. The review concludes with a reflection on the impact of the new PSPS nomenclature on the perception and management of post-surgical spinal pain.
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Affiliation(s)
- Grzegorz Miękisiak
- Institute of Medicine, University of Opole, 45-040 Opole, Poland
- Vratislavia Medica Hospital, 51-134 Wrocław, Poland
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El Yaagoubi Y, Loret JE, Lioret E, Thomas C, Simonneau A, Vinikoff L, Prunier-Aesch C, Chetanneau A, Philippe L, Ogielska M, Bernard L. 18F-NaF PET/CT in Presumed Aseptic Pseudarthrosis after Spinal Fusion: Correlation with Findings at Revision Surgery and Intraoperative Cultures. World J Nucl Med 2022; 21:302-313. [DOI: 10.1055/s-0042-1750400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Background Conventional imaging is useful to assess interbody fusion by showing complete trabecular bony bridging, but has a low positive predictive value for pseudarthrosis. Because alterations of bone metabolism may precede structural anatomical changes on computed tomography (CT), we aimed to investigate the ability of fluorine 18 sodium fluoride positron emission tomography/computed tomography (18F-NaF PET/CT) to identify pseudarthrosis after spinal fusion using surgical revision as the reference standard.
Methods We retrospectively reviewed 18F-NaF PET/CT scans performed between February 2019 and September 2020 in patients experiencing pain after spinal fusion. We included the 18 patients who underwent revision surgery for suspicion of pseudarthrosis. Five consecutive patients who were clearly fused on CT served as the control group.
Results In the revision surgery group (n=18), visual assessment by 18F-NaF PET/CT revealed that all 22 cages with an increased 18F-NaF uptake around intercorporal fusion material had mobility at revision surgery, whereas none of the fused patients (n=5) showed uptake around cage/intervertebral disk space. Among the 18 patients with presumed aseptic pseudarthrosis, intraoperative cultures revealed surgical site infection (SSI) caused by Cutibacterium acnes (C. acnes) in seven patients (38.9%). There was a statistically significant difference in standardized uptake values and uptake ratios between the revision surgery and control groups (p=5.3× 10−6 and p=0.0002, respectively).
Conclusions 18F-NaF PET/CT imaging appeared as a useful tool to identify pseudarthrosis following spinal fusion. The unexpectedly high prevalence (38.9%) of SSI caused by C. acnes found in presumed aseptic patients supports the utility of intraoperative cultures in revision cases for pseudarthrosis, even without preoperative clinical suspicion of SSI.
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Affiliation(s)
- Yacine El Yaagoubi
- Department of Nuclear Medicine, Vinci Clinic, Alexandre Minkowski, Chambray-lès-Tours, France
| | | | - Eric Lioret
- Department of Neurosurgery, Vinci Clinic, Alexandre Minkowski, Chambray-lès-Tours, France
| | - Clément Thomas
- Department of Neurosurgery, Vinci Clinic, Alexandre Minkowski, Chambray-lès-Tours, France
| | - Adrien Simonneau
- Department of Neurosurgery, NCT+ Clinic, Saint-Cyr-sur-Loire, France
| | - Laurent Vinikoff
- Department of Neurosurgery, NCT+ Clinic, Saint-Cyr-sur-Loire, France
| | - Caroline Prunier-Aesch
- Department of Nuclear Medicine, Vinci Clinic, Alexandre Minkowski, Chambray-lès-Tours, France
| | - Alain Chetanneau
- Department of Nuclear Medicine, Vinci Clinic, Alexandre Minkowski, Chambray-lès-Tours, France
| | - Laurent Philippe
- Department of Nuclear Medicine, Vinci Clinic, Alexandre Minkowski, Chambray-lès-Tours, France
| | - Maja Ogielska
- Department of Infectious Diseases, Vinci Clinic, Alexandre Minkowski, Chambray-lès-Tours, France
| | - Louis Bernard
- Department of Infectious Diseases, Bretonneau University Hospital, Tonnellé, Tours, France
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Manhas NS, Salehi S, Joyce P, Guermazi A, Ahmadzadehfar H, Gholamrezanezhad A. PET/Computed Tomography Scans and PET/MR Imaging in the Diagnosis and Management of Musculoskeletal Diseases. PET Clin 2020; 15:535-545. [DOI: 10.1016/j.cpet.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zhang V, Koa B, Borja AJ, Padmanhabhan S, Bhattaru A, Raynor WY, Rojulpote C, Seraj SM, Werner TJ, Rajapakse C, Alavi A, Revheim ME. Diagnosis and Monitoring of Osteoporosis with Total-Body 18F-Sodium Fluoride-PET/CT. PET Clin 2020; 15:487-496. [PMID: 32768370 DOI: 10.1016/j.cpet.2020.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In recent years, 18F-Sodium Fluoride (NaF)-PET/CT has seen its role in the detection and management of osteoporosis increase. This article reviews the extent of this application in the literature, its efficacy compared with other comparable imaging tools, and how total-body PET/CT combined with global disease assessment can revolutionize measurement of total osteoporotic disease activity. NaF-PET/CT eventually can be the modality of choice for metabolic bone disorders, especially with these advances in technology and computation.
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Affiliation(s)
- Vincent Zhang
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin Koa
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Drexel University College of Medicine, Philadelphia, PA, USA
| | - Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sayuri Padmanhabhan
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Abhijit Bhattaru
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Drexel University College of Medicine, Philadelphia, PA, USA
| | - Chaitanya Rojulpote
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | | | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Chamith Rajapakse
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Mona-Elisabeth Revheim
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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