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Blanco-Giménez P, Vicente-Mampel J, Gargallo P, Maroto-Izquierdo S, Martín-Ruíz J, Jaenada-Carrilero E, Barrios C. Effect of exercise and manual therapy or kinesiotaping on sEMG and pain perception in chronic low back pain: a randomized trial. BMC Musculoskelet Disord 2024; 25:583. [PMID: 39054514 PMCID: PMC11270888 DOI: 10.1186/s12891-024-07667-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
The importance of incorporating lumbo-pelvic stability core and controlling motor exercises in patients with chronic low back pain (CLBP) reinforces the use of strategies to improve biopsychosocial beliefs by reducing biomedical postulations. However, clinical practice guidelines recommend multimodal approaches incorporating exercise and manual therapy (MT), and instead reject the application of kinesiotape (KT) in isolation. Therefore, the objectives of this study were to analyze the effects of 12 weeks of exercises combined with MT or KT on perceived low back pain using the visual analog scale (VAS) and muscle electric activity measured with electromyography (EMG) of the rectus abdominis and multifidus in CLBP (mild disability) and to explore the relationship between the rectus abdominis and multifidus ratios and pain perception after intervention. A blinded, 12-week randomized controlled trial (RCT) was carried out, involving three parallel groups of patients with CLBP. The study was registered at Clinicaltrial.gov and assigned the identification number NCT05544890 (19/09/22). The trial underwent an intention-to-treat analysis. The primary outcome revealed a multimodal treatment program supplemented by additional therapies such as MT and KT, resulting in significant reductions in perceived low back pain. The subjective assessment of individuals with CLBP indicated no discernible distinction between exclusive core stability exercises and control-motor training when combined with MT or KT. Notably, our findings demonstrated positive alterations in both the mean and peak EMG values of the right rectus abdominis in the exercise group, suggesting a beneficial impact on muscle activation. This study focused on assessing the activation levels of the trunk musculature, specifically the rectus abdominis (RA) and multifidus (MF), in individuals with CLBP exhibiting mild disability according to the Oswestry Disability Index. Importantly, improvements in the VAS values were observed independently of changes in muscle electrical activity.
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Affiliation(s)
- P Blanco-Giménez
- Doctoral School, Catholic University of Valencia San Vicente Mártir, Valencia, Spain
- School of Medicine and Health Science, Department of Physiotherapy, Catholic University of Valencia, Torrent, Valencia, Spain
| | - J Vicente-Mampel
- School of Medicine and Health Science, Department of Physiotherapy, Catholic University of Valencia, Torrent, Valencia, Spain.
- Faculty of Medicine and Health Science, Department of Physiotherapy, Catholic University of Valencia, Torrent, Valencia, Spain.
| | - P Gargallo
- School of Medicine and Health Science, Department of Physiotherapy, Catholic University of Valencia, Torrent, Valencia, Spain
| | | | - J Martín-Ruíz
- Faculty of Sciences of Physical Activity and Sport, Department of Health and Functional Assessment, Catholic University of Valencia, Torrent, Valencia, Spain
| | - E Jaenada-Carrilero
- School of Medicine and Health Science, Department of Physiotherapy, Catholic University of Valencia, Torrent, Valencia, Spain
| | - C Barrios
- Institute for Research on Musculoskeletal Disorders, School of Medicine and Health Sciences, Valencia Catholic University, Valencia, Spain
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Yeo J. Failed back surgery syndrome-terminology, etiology, prevention, evaluation, and management: a narrative review. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2024; 41:166-178. [PMID: 38853538 PMCID: PMC11294787 DOI: 10.12701/jyms.2024.00339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 06/11/2024]
Abstract
Amid the worldwide increase in spinal surgery rates, a significant proportion of patients continue to experience refractory chronic pain, resulting in reduced quality of life and escalated healthcare demands. Failed back surgery syndrome (FBSS) is a clinical condition characterized by persistent or recurrent pain after one or more spinal surgeries. The diverse characteristics and stigmatizing descriptions of FBSS necessitate a reevaluation of its nomenclature to reflect its complexity more accurately. Accurate identification of the cause of FBSS is hampered by the complex nature of the syndrome and limitations of current diagnostic labels. Management requires a multidisciplinary approach that may include pharmacological treatment, physical therapy, psychological support, and interventional procedures, emphasizing realistic goal-setting and patient education. Further research is needed to increase our understanding, improve diagnostic accuracy, and develop more effective management strategies.
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Affiliation(s)
- Jinseok Yeo
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
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Peters MJM, Brans BT, Broos WAM, Jutten EMC, Mottaghy FM, Schijns O, Weijers RE, Willems PC. The Use of 18F-Fluoride Positron Emission Tomography/Computed Tomography Scanning to Identify Sources of Pain after Posterior Lumbar Interbody Fusion-An Analysis in Patients with and without Symptoms. Diagnostics (Basel) 2024; 14:1327. [PMID: 39001218 PMCID: PMC11240620 DOI: 10.3390/diagnostics14131327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Identifying the cause of recurrent or persisting pain after posterior lumbar interbody fusion (PLIF) is essential for establishing optimal treatment. In this study, we evaluate patients after PLIF surgery by 18F-fluoride PET/CT scans and patient-reported outcome measures (PROMs). METHODS A total of 36 PLIF patients were included. Sixty minutes after intravenous injection of 18F-fluoride, PET/CT scanning was performed. Bone graft ingrowth, subsidence, screw loosening and damage of facet joints were scored by quantifying the level of bone metabolism of the vertebral endplates in the disc spaces, around screws and around the facet joints on the PET scans. RESULTS In contrast to asymptomatic patients, symptomatic patients showed abnormal PET values around pedicle screws and/or facet joints and at the lower endplates of the disc spaces, identifying a possible source of pain. On CT, no significant differences between these two groups were found. CONCLUSION The PET/CT findings appeared to correlate better with symptoms on PROMs compared to CT findings alone. When interpreting 18F-fluoride PET/CT findings after PLIF surgery, one should realize bone metabolism in the disc spaces of the operated segments and around pedicle screws or facet joint changes during follow-up, reflecting natural recovery.
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Affiliation(s)
- Marloes J. M. Peters
- Department of Orthopaedic Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (M.J.M.P.); (E.M.C.J.)
| | - Boudewijn T. Brans
- Department of Nuclear Medicine, Albert Schweitzer Ziekenhuis, 3318 AT Dordrecht, The Netherlands; (B.T.B.); (W.A.M.B.)
| | - Wouter A. M. Broos
- Department of Nuclear Medicine, Albert Schweitzer Ziekenhuis, 3318 AT Dordrecht, The Netherlands; (B.T.B.); (W.A.M.B.)
| | - Elisabeth M. C. Jutten
- Department of Orthopaedic Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (M.J.M.P.); (E.M.C.J.)
| | - Felix M. Mottaghy
- Department of Nuclear Medicine and Radiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (F.M.M.); (R.E.W.)
- Department of Nuclear Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Olaf Schijns
- Department of Neurosurgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands;
| | - René E. Weijers
- Department of Nuclear Medicine and Radiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (F.M.M.); (R.E.W.)
| | - Paul C. Willems
- Department of Orthopaedic Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (M.J.M.P.); (E.M.C.J.)
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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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Rigoard P, Moens M, Goudman L, Le Tutour T, Rochette M, Dany J, Et Talby M, Roulaud M, Hervochon R, Ounajim A, Nivole K, David R, Billot M. "Neuro-Fiber Mapping": An Original Concept of Spinal Cord Neural Network Spatial Targeting Using Live Electrostimulation Mapping to (Re-)Explore the Conus Medullaris Anatomy. J Clin Med 2023; 12:jcm12051747. [PMID: 36902533 PMCID: PMC10002982 DOI: 10.3390/jcm12051747] [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: 11/21/2022] [Revised: 01/16/2023] [Accepted: 01/26/2023] [Indexed: 02/24/2023] Open
Abstract
Spinal cord (SC) anatomy is often assimilated to a morphologically encapsulated neural entity, but its functional anatomy remains only partially understood. We hypothesized that it could be possible to re-explore SC neural networks by performing live electrostimulation mapping, based on "super-selective" spinal cord stimulation (SCS), originally designed as a therapeutical tool to address chronic refractory pain. As a starting point, we initiated a systematic SCS lead programming approach using live electrostimulation mapping on a chronic refractory perineal pain patient, previously implanted with multicolumn SCS at the level of the conus medullaris (T12-L1). It appeared possible to (re-)explore the classical anatomy of the conus medullaris using statistical correlations of paresthesia coverage mappings, resulting from 165 different electrical configurations tested. We highlighted that sacral dermatomes were not only located more medially but also deeper than lumbar dermatomes at the level of the conus medullaris, in contrast with classical anatomical descriptions of SC somatotopical organization. As we were finally able to find a morphofunctional description of "Philippe-Gombault's triangle" in 19th-century historical textbooks of neuroanatomy, remarkably matching these conclusions, the concept of "neuro-fiber mapping" was introduced.
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Affiliation(s)
- Philippe Rigoard
- PRISMATICS Laboratory (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86000 Poitiers, France
- Department of Neuro-Spine & Neuromodulation, Poitiers University Hospital, 86000 Poitiers, France
- PPrime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, 86000 Poitiers, France
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
- STIMULUS Consortium (Research and Teaching Neuromodulation uz Brussel), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
- STIMULUS Consortium (Research and Teaching Neuromodulation uz Brussel), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1090 Brussels, Belgium
| | - Tom Le Tutour
- PRISMATICS Laboratory (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86000 Poitiers, France
- ANSYS France, 69100 Villeurbanne, France
| | | | - Jonathan Dany
- PRISMATICS Laboratory (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86000 Poitiers, France
- Department of Neuro-Spine & Neuromodulation, Poitiers University Hospital, 86000 Poitiers, France
| | - Mohamed Et Talby
- PRISMATICS Laboratory (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86000 Poitiers, France
- Department of Neuro-Spine & Neuromodulation, Poitiers University Hospital, 86000 Poitiers, France
| | - Manuel Roulaud
- PRISMATICS Laboratory (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86000 Poitiers, France
| | - Rémi Hervochon
- Department of Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, 47–83 Boulevard de l’Hôpital, 75013 Paris, France
| | - Amine Ounajim
- PRISMATICS Laboratory (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86000 Poitiers, France
| | - Kévin Nivole
- PRISMATICS Laboratory (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86000 Poitiers, France
| | - Romain David
- PRISMATICS Laboratory (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86000 Poitiers, France
- Department of Physical and Rehabilitation Medicine, Poitiers University Hospital, University of Poitiers, 86000 Poitiers, France
| | - Maxime Billot
- PRISMATICS Laboratory (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86000 Poitiers, France
- Correspondence:
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Baranidharan G, Bretherton B, Black S. A case series of new radicular pain following the insertion of spinal cord stimulator. Br J Pain 2022; 16:450-457. [PMID: 36032340 PMCID: PMC9411753 DOI: 10.1177/20494637221084187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Purpose Although spinal cord stimulation (SCS) is a safe procedure, equipment-related, biological and neurological complications have been observed in previous research, particularly case reports. No reports of new neuropathic pain in the absence of neurological deficit or positive MRI findings have been described. We detail three cases of new-onset radicular pain in the L5/S1 dermatome following insertion of SCS. Methods This was a retrospective case series of three patients. Details of clinical background, indications for SCS and events occurring during insertion and further management were recorded. Results All three cases were technically difficult and required multiple epidural entry levels, with repeated passage of the electrode into and within the epidural space. All cases involved accessing epidural space T12/L1 and L1/L2. A possible explanation for the new-onset radicular pain could concern oedema to the conus medullaris, resulting from repeated passage of the electrode at the T12/L1 level. Alternative explanations could be direct trauma to transiting nerve roots, neuroplastic changes resulting in peripheral and central sensitisation and immune-mediated nerve injury. Conclusion MRI imaging should be analysed prior to the SCS procedure to identify the level of the conus medullaris, with the aim of avoiding repeated passage of electrodes at that level. Unintended neurological adverse events should be discussed with patients during the consent process. Careful patient selection and psychological screening may also help identify patients who may be unlikely to respond to SCS therapy. Further reporting of new radiculopathic pain following SCS insertion is required to strengthen understanding of its potential causes.
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Affiliation(s)
- Ganesan Baranidharan
- Pain Management Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Faculty of Medicine and Health, School of Medicine, University of Leeds, Leeds, UK
| | - Beatrice Bretherton
- Pain Management Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Faculty of Biological Sciences, School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Sheila Black
- Pain Management Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Alves Rodrigues T, de Oliveira EJSG, Morais Costa B, Tajra Mualem Araújo RL, Batista Santos Garcia J. Is There a Difference in Fear-Avoidance, Beliefs, Anxiety and Depression Between Post-Surgery and Non-Surgical Persistent Spinal Pain Syndrome Patients? J Pain Res 2022; 15:1707-1717. [PMID: 35734508 PMCID: PMC9208625 DOI: 10.2147/jpr.s348146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/05/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Patients with post-surgery persistent spinal pain syndrome (PSPS) or non-surgical PSPS might be affected by sustained fear-avoidance beliefs (FAB), anxiety and depression. In this scenario, this study aimed to describe those aspects in patients with post-surgery PSPS and non-surgical PSPS. Methods This study included patients with PSPS, and non-surgical PSPS, over 18 years, with quarterly evaluations at the Chronic Pain Clinic. After evaluation, demographic and clinical characteristics were obtained. The Beck Depression Inventory-II, Beck Anxiety Inventory, Douleur neuropathique 4 questions, Visual Analog Pain Scale, and Fear-Avoidance Beliefs Questionnaire-Brazilian Version (FABQ-Brazil) were used to evaluate psychological aspects. Results Forty-six patients were included, 23 patients with post-surgery PSPS and 23 with non-surgical PSPS. Both groups had high scores in the physical and work domains of the FABQ, high rates of absenteeism and most patients in these groups had moderate-to-severe neuropathic pain and some degree of anxiety and/or depression. The groups showed no statistically significant difference (p > 0.05) when comparing all questionnaires. Discussion This is one of the first studies to evaluate FAB and other associated psychological factors, such as anxiety and depression, in patients with post-surgery PSPS in a follow-up several years after surgery and compare with patients diagnosed with non-surgical PSPS. In this study, most patients in both groups had high scores in the FABQ domains, not having statistically relevant difference between groups. Conclusion Even though there was no statistically relevant difference between the PSPS patient with or without surgical history in terms of the assessed outcome measures, the described scores for fear-avoidance beliefs, pain, anxiety and depression were high, showing an interference in the daily life activities of those patients.
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Affiliation(s)
- Thiago Alves Rodrigues
- Chronic Pain Clinic, University Hospital of the Federal University of Maranhão (HU-UFMA), São Luís, Maranhão, Brazil
| | | | - Beatriz Morais Costa
- Chronic Pain Clinic, University Hospital of the Federal University of Maranhão (HU-UFMA), São Luís, Maranhão, Brazil
| | | | - João Batista Santos Garcia
- Chronic Pain Clinic, University Hospital of the Federal University of Maranhão (HU-UFMA), São Luís, Maranhão, Brazil
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Singh R, Prasad RS, Singh A, Singh K, Sahu A. Traumatic Spondyloptosis: Neurological, Surgical, and Outcome Perspectives in a Tertiary Care Center. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1726608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Objective To evaluate traumatic spondyloptosis cases for neurological, surgical, and outcome perspectives.
Materials and Methods This retrospective study includes 17 patients of spondyloptosis admitted in our department between August 2016 and January 2020. Each patient was evaluated in terms of demographic profile, clinical presentation, duration of injury, mode of injury, associated injuries, level and type of spondyloptosis, spinal cord status, nociceptive and neuropathic pain severity, severity of injury based on International Standards for Neurological Classification of Spinal Cord Injury (ISNCSI) assessment, surgical approaches, complications, and outcome. Unpaired t- test and Chi-square test were used for statistical analysis. Values with p < 0.05 were considered statistically significant.
Results Fall from height (58.8%) was the most common mode of injury. Most common level of spondyloptosis was T12–L1 (41.1%). Sagittal–plane spondyloptosis (76.5%) were more common than coronal–plane spondyloptosis (23.5%). Most common associated injury was musculoskeletal (64.7%). Neurological status of the patient at presentation (p = 0.0007) was significantly associated with outcome after 3 months of surgery/conservative management. Residual listhesis was present in 53.3% of patients postoperatively. Postoperative nociceptive pain (p = 0.0171) and neuropathic pain (0.0329) were significantly associated with residual listhesis. Duration of injury (p = 0.0228) was also significantly associated with postoperative residual listhesis.
Conclusion Complete reduction of spondyloptosis should be the goal of surgery. Overall prognosis of spinal cord injury (SCI) due to traumatic spondyloptosis is poor.
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Affiliation(s)
- Rahul Singh
- Department of Neurosurgery, Institute of Medical Sciences–Banaras Hindu University, Varanasi, India
| | - Ravi Shankar Prasad
- Department of Neurosurgery, Institute of Medical Sciences–Banaras Hindu University, Varanasi, India
| | - Ashvamedh Singh
- Department of Neurosurgery, Institute of Medical Sciences–Banaras Hindu University, Varanasi, India
| | - Kulwant Singh
- Department of Neurosurgery, Institute of Medical Sciences–Banaras Hindu University, Varanasi, India
| | - Anurag Sahu
- Department of Neurosurgery, Institute of Medical Sciences–Banaras Hindu University, Varanasi, India
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Rigoard P, Ounajim A, Goudman L, Bouche B, Roulaud M, Page P, Lorgeoux B, Baron S, Nivole K, Many M, Adjali N, Charrier E, Rannou D, Poupin L, Wood C, David R, Héraud D, Moens M, Billot M. The Added Value of Subcutaneous Peripheral Nerve Field Stimulation Combined with SCS, as Salvage Therapy, for Refractory Low Back Pain Component in Persistent Spinal Pain Syndrome Implanted Patients: A Randomized Controlled Study (CUMPNS Study) Based on 3D-Mapping Composite Pain Assessment. J Clin Med 2021; 10:5094. [PMID: 34768614 PMCID: PMC8584602 DOI: 10.3390/jcm10215094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/13/2021] [Accepted: 10/26/2021] [Indexed: 02/06/2023] Open
Abstract
While Spinal Cord Stimulation (SCS) provides satisfaction to almost 2/3 of Persistent Spinal Pain Syndrome-Type 2 (PSPS-T2) patients implanted for refractory chronic back and/or leg pain, when not adequately addressed the back pain component, leaves patients in a therapeutic cul-de-sac. Peripheral Nerve field Stimulation (PNfS) has shown interesting results addressing back pain in the same population. Far from placing these two techniques in opposition, we suggest that these approaches could be combined to better treat PSPS-T2 patients. We designed a RCT (CUMPNS), with a 12-month follow-up, to assess the potential added value of PNfS, as a salvage therapy, in PSPS-T2 patients experiencing a "Failed SCS Syndrome" in the back pain component. Fourteen patients were included in this study and randomized into 2 groups ("SCS + PNfS" group/n = 6 vs. "SCS only" group/n = 8). The primary objective of the study was to compare the percentage of back pain surface decrease after 3 months, using a computerized interface to obtain quantitative pain mappings, combined with multi-dimensional SCS outcomes. Back pain surface decreased significantly greater for the "SCS + PNfS" group (80.2% ± 21.3%) compared to the "SCS only" group (13.2% ± 94.8%) (p = 0.012), highlighting the clinical interest of SCS + PNfS, in cases where SCS fails to address back pain.
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Affiliation(s)
- Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
- Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 86021 Poitiers, France
- Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, 86360 Chasseneuil-du-Poitou, France
| | - Amine Ounajim
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (L.G.); (M.M.)
- STIMULUS Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Benedicte Bouche
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Philippe Page
- STIMULUS Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Bertille Lorgeoux
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Sandrine Baron
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Kevin Nivole
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Mathilde Many
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Nihel Adjali
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Elodie Charrier
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, 86021 Poitiers, France; (E.C.); (D.R.); (L.P.)
| | - Delphine Rannou
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, 86021 Poitiers, France; (E.C.); (D.R.); (L.P.)
| | - Laure Poupin
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, 86021 Poitiers, France; (E.C.); (D.R.); (L.P.)
| | - Chantal Wood
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Romain David
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
- Physical and Rehabilitation Medicine Unit, Poitiers University Hospital, University of Poitiers, 86021 Poitiers, France
| | - Dylan Héraud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Maartens Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (L.G.); (M.M.)
- STIMULUS Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
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10
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Rigoard P, Ounajim A, Goudman L, Louis PY, Slaoui Y, Roulaud M, Naiditch N, Bouche B, Page P, Lorgeoux B, Baron S, Charrier E, Poupin L, Rannou D, de Montgazon GB, Roy-Moreau B, Grimaud N, Adjali N, Nivole K, Many M, David R, Wood C, Rigoard R, Moens M, Billot M. A Novel Multi-Dimensional Clinical Response Index Dedicated to Improving Global Assessment of Pain in Patients with Persistent Spinal Pain Syndrome after Spinal Surgery, Based on a Real-Life Prospective Multicentric Study (PREDIBACK) and Machine Learning Techniques. J Clin Med 2021; 10:4910. [PMID: 34768428 PMCID: PMC8585086 DOI: 10.3390/jcm10214910] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 01/01/2023] Open
Abstract
The multidimensionality of chronic pain forces us to look beyond isolated assessment such as pain intensity, which does not consider multiple key parameters, particularly in post-operative Persistent Spinal Pain Syndrome (PSPS-T2) patients. Our ambition was to produce a novel Multi-dimensional Clinical Response Index (MCRI), including not only pain intensity but also functional capacity, anxiety-depression, quality of life and quantitative pain mapping, the objective being to achieve instantaneous assessment using machine learning techniques. Two hundred PSPS-T2 patients were enrolled in the real-life observational prospective PREDIBACK study with 12-month follow-up and received various treatments. From a multitude of questionnaires/scores, specific items were combined, as exploratory factor analyses helped to create a single composite MCRI; using pairwise correlations between measurements, it appeared to more accurately represent all pain dimensions than any previous classical score. It represented the best compromise among all existing indexes, showing the highest sensitivity/specificity related to Patient Global Impression of Change (PGIC). Novel composite indexes could help to refine pain assessment by informing the physician's perception of patient condition on the basis of objective and holistic metrics, and also by providing new insights regarding therapy efficacy/patient outcome assessments, before ultimately being adapted to other pathologies.
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Affiliation(s)
- Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (N.N.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (R.D.); (C.W.); (M.B.)
- Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 86021 Poitiers, France;
- Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, 86360 Chasseneuil-du-Poitou, France
| | - Amine Ounajim
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (N.N.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (R.D.); (C.W.); (M.B.)
- Laboratoire de Mathématiques et Applications UMR 7348, CNRS, University of Poitiers, 86073 Poitiers, France;
| | - Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (L.G.); (M.M.)
- STIMULUS Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Pierre-Yves Louis
- AgroSup Dijon, PAM UMR 02.102, Université Bourgogne Franche-Comté, 21000 Dijon, France;
- Institut de Mathématiques de Bourgogne, UMR 5584 CNRS, Université Bourgogne Franche-Comté, 21000 Dijon, France
| | - Yousri Slaoui
- Laboratoire de Mathématiques et Applications UMR 7348, CNRS, University of Poitiers, 86073 Poitiers, France;
| | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (N.N.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (R.D.); (C.W.); (M.B.)
| | - Nicolas Naiditch
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (N.N.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (R.D.); (C.W.); (M.B.)
| | - Bénédicte Bouche
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (N.N.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (R.D.); (C.W.); (M.B.)
- Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 86021 Poitiers, France;
| | - Philippe Page
- Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 86021 Poitiers, France;
| | - Bertille Lorgeoux
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (N.N.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (R.D.); (C.W.); (M.B.)
| | - Sandrine Baron
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (N.N.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (R.D.); (C.W.); (M.B.)
| | - Elodie Charrier
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, 86021 Poitiers, France; (E.C.); (L.P.); (D.R.)
| | - Laure Poupin
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, 86021 Poitiers, France; (E.C.); (L.P.); (D.R.)
| | - Delphine Rannou
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, 86021 Poitiers, France; (E.C.); (L.P.); (D.R.)
| | | | - Brigitte Roy-Moreau
- Pain Evaluation and Treatment Centre, Nord Deux-Sèvres Hospital, 79000 Niort, France;
| | - Nelly Grimaud
- Pain Evaluation and Treatment Centre, Centre Clinical Elsan, 16800 Soyaux, France;
| | - Nihel Adjali
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (N.N.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (R.D.); (C.W.); (M.B.)
| | - Kevin Nivole
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (N.N.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (R.D.); (C.W.); (M.B.)
| | - Mathilde Many
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (N.N.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (R.D.); (C.W.); (M.B.)
| | - Romain David
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (N.N.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (R.D.); (C.W.); (M.B.)
- Physical and Rehabilitation Medicine Unit, Poitiers University Hospital, University of Poitiers, 86021 Poitiers, France
| | - Chantal Wood
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (N.N.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (R.D.); (C.W.); (M.B.)
| | - Raphael Rigoard
- CEA Cadarache, Département de Support Technique et Gestion, Service des Technologies de l’Information et de la Communication, 13108 Saint-Paul-Lez-Durance, France;
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (L.G.); (M.M.)
- STIMULUS Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (N.N.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (R.D.); (C.W.); (M.B.)
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11
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Efficacy of liposomal bupivacaine in spine surgery: a systematic review. Spine J 2021; 21:1450-1459. [PMID: 33618032 DOI: 10.1016/j.spinee.2021.02.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spine surgery with posterior approaches may involve extensive manipulation of native structures, resulting in significant postoperative pain. Liposomal bupivacaine (LB) is an injectable analgesic that has demonstrated efficacy in decreasing postoperative pain and opioid requirements in patients across multiple surgical subspecialties. PURPOSE To consolidate and analyze the findings of retrospective cohort-matched studies and prospective randomized controlled trials investigating the use of LB in spine surgery. STUDY DESIGN A systematic review. STUDY SAMPLE Retrospective cohort-matched studies and randomized controlled trials (RCTs) investigating the efficacy of injected LB in spinal surgery compared with a control/no treatment group. METHODS MEDLINE, Cochrane controlled trials register, and Google Scholar were searched to identify all studies that examined the effect of LB use on outcomes in spine surgery. Our search identified 10 articles that independently evaluated the effect of LB on reduction of postoperative opioid use, pain scores, hospital length of stay, cost, and incidence of adverse effects. The principles of GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) were applied to assess the quality of evidence from each study. RESULTS Ten studies were analyzed (1,112 total patients). LB was associated with significantly lower millimolar morphine equivalents (MME) of postoperative opioids, especially in opiate-tolerant patients, visual analog scale (VAS) scores, area under the curve (AUC) of cumulative pain scores, numeric pain scale scores, and hospital length of stay (LOS), with comparable or lower odds of adverse effects relative to controls. CONCLUSIONS Low-quality evidence suggests that liposomal bupivacaine may safely decrease postoperative opioid requirements, pain scores, and length of stay in patients undergoing spine surgery, whereas moderate-quality evidence does not support its use at this time. Therefore, additional standardized well-powered prospective studies are necessary to more clearly assess the efficacy of LB in spine surgery.
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12
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Radcliff K, Zigler J, Braxton E, Buttermann G, Coric D, Derman P, Garcia R, Jorgensen A, Ferko NC, Situ A, Yue J. Final Long-Term Reporting from a Randomized Controlled IDE Trial for Lumbar Artificial Discs in Single-Level Degenerative Disc Disease: 7-Year Results. Int J Spine Surg 2021; 15:612-632. [PMID: 34266934 PMCID: PMC8375685 DOI: 10.14444/8083] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study compared 7-year safety and efficacy outcomes of activL and ProDisc-L lumbar total disc replacements in patients with symptomatic, single-level lumbar degenerative disc disease (DDD). The objectives are to report 7-year outcomes of the trial, evaluate the outcomes for patients lost to follow-up, and determine whether early outcomes predict long-term outcomes. METHODS This was a prospective, multicenter, randomized, controlled investigational device exemption study. Eligible patients with symptomatic, single-level lumbar DDD had failed ≥6 months of nonsurgical management. Patients (N = 283) were randomized to receive activL (n = 218) or ProDisc-L (n = 65). At 7 years, data were available from 206 patients (activL, 160; ProDisc-L, 46). Logistic regression models were fit to predict 7-year outcomes for patients lost to follow-up after 2 years. RESULTS At 7 years, the activL group was noninferior to the ProDisc-L group on the primary composite endpoint (P = .0369). Both groups showed significant reductions in back/leg pain severity and improvements in disability index and quality-of-life relative to baseline (P < .0001). In both groups, opioid use was significantly reduced at 7 years (0%) relative to baseline (P < .01), and the overall reoperation rates were low (4.6%). activL patients showed a significantly better range of motion (ROM) for flexion-extension rotation than ProDisc-L patients (P = .0334). A significantly higher proportion of activL patients did not report serious adverse events (activL, 62%; ProDisc-L, 43%; P = .011). Predictive modeling indicated that >70% of patients (depending on outcome) lost to follow-up after 2 years would show clinically significant improvement at 7 years if improvements were achieved at 2 years. CONCLUSIONS The benefits of activL and ProDisc-L are maintained after 7 years, with significant improvements from baseline observed in pain, function, and opioid use. activL is more effective at preserving ROM than ProDisc-L and has a more favorable safety profile. Improvements in other primary and secondary outcomes were similar between both disc designs. LEVEL OF EVIDENCE 1.
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Affiliation(s)
- Kris Radcliff
- Rothman Orthopedic Institute, Philadelphia, Pennsylvania
| | | | - Ernest Braxton
- Vail Health Vail Summit Orthopaedics and Neurosurgery, Vail, Colorado
| | | | - Dom Coric
- Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | | | | | | | | | - Aaron Situ
- CRG-EVERSANA Canada, Inc, Burlington, Ontario, Canada
| | - James Yue
- Frank H. Netter School of Medicine, Quinnipiac University, Hamden, Connecticut
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13
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Monticone M, Ambrosini E, Rocca B, Cazzaniga D, Liquori V, Lovi A, Brayda-Bruno M. Multimodal exercises integrated with cognitive-behavioural therapy improve disability of patients with failed back surgery syndrome: a randomized controlled trial with one-year follow-up. Disabil Rehabil 2020; 44:3422-3429. [PMID: 33356640 DOI: 10.1080/09638288.2020.1863480] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the effect of multimodal exercises integrated with cognitive-behavioural therapy on disability, pain, and quality of life in patients suffering from failed back surgery syndrome (FBSS), and to appraise its extent in the long term. METHODS By means of a parallel-group superiority-controlled trial, 150 outpatients were randomly assigned to a 10-week individual-based multimodal programme of task-oriented exercises integrated with cognitive-behavioural therapy (experimental group, 75 patients) or individual-based general physiotherapy (control group, 75 patients). Before treatment, 10 weeks later (post-treatment), and 12 months after the end of treatment, the Oswestry Disability Index (primary outcome), the Tampa Scale for Kinesiophobia, the Pain Catastrophising Scale, a pain intensity numerical rating scale and the Short-Form Health Survey were evaluated. Linear mixed model analysis for repeated measures was carried out for each outcome measure. RESULTS Significant group (p < 0.001), time (p < 0.001), and time-by-group interaction (p < 0.001) effects were found for all outcome measures. Concerning disability, between-group differences (95% confidential interval) in favour of the experimental group of -9 (-10.7; -7.3) after training and of -13.2 (-14.7; -11.7) at follow-up were found. Also, kinesiophobia, catastrophising and pain showed significant between-group differences of 9, 12.5 and 1.7 points, respectively. CONCLUSION The multimodal intervention proposed was superior to general physiotherapy in reducing disability, kinesiophobia, catastrophising, and enhancing the quality of life of patients with FBSS. The effects were reinforced one year after the programme ended.IMPLICATIONS FOR REHABILITATIONMultimodal exercises integrated with cognitive-behavioural therapy induced significant improvements in disability, pain, kinesiophobia, catastrophising, and quality of life of subjects with Failed Back Surgery Syndrome.A well-integrated rehabilitative team which contributes towards reaching intervention goals is advised.Physiotherapists should adopt task-oriented exercises to promote an earlier return to common activities of disabled patients.Psychologists should explain how to modify useless beliefs and support adequate behaviours, in order to produce constructive attitudes towards perceived disability.
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Affiliation(s)
- Marco Monticone
- Physical Medicine and Rehabilitation, Department of Medical Sciences and Public Health, University of Cagliari.,Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy
| | - Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Barbara Rocca
- Physical Medicine and Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Italy
| | - Daniele Cazzaniga
- Physical Medicine and Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Italy
| | - Valentina Liquori
- Physical Medicine and Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Italy
| | - Alessio Lovi
- Unit of Spinal Orthopaedics Surgery, Galeazzi Hospital, IRRCS, Milan, Italy
| | - Marco Brayda-Bruno
- Unit of Spinal Orthopaedics Surgery, Galeazzi Hospital, IRRCS, Milan, Italy
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14
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Rigoard P, Billot M, Ingrand P, Durand-Zaleski I, Roulaud M, Peruzzi P, Dam Hieu P, Voirin J, Raoul S, Page P, Djian MC, Fontaine D, Lantéri-Minet M, Blond S, Buisset N, Cuny E, Cadenne M, Caire F, Ranoux D, Mertens P, Naous H, Simon E, Emery E, Béraud G, Debiais F, Durand G, Serrie A, Diallo B, Bulsei J, Ounajim A, Nivole K, Duranton S, Naiditch N, Monlezun O, Bataille B. How Should we Use Multicolumn Spinal Cord Stimulation to Optimize Back Pain Spatial Neural Targeting? A Prospective, Multicenter, Randomized, Double-Blind, Controlled Trial (ESTIMET Study). Neuromodulation 2020; 24:86-101. [PMID: 32865344 DOI: 10.1111/ner.13251] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent studies have highlighted multicolumn spinal cord stimulation (SCS) efficacy, hypothesizing that optimized spatial neural targeting provided by new-generation SCS lead design or its multicolumn programming abilities could represent an opportunity to better address chronic back pain (BP). OBJECTIVE To compare multicolumn vs. monocolumn programming on clinical outcomes of refractory postoperative chronic BP patients implanted with SCS using multicolumn surgical lead. MATERIALS AND METHODS Twelve centers included 115 patients in a multicenter, randomized, double-blind, controlled trial. After randomization, leads were programmed using only one or several columns. The primary outcome was change in BP visual analogic scale (VAS) at six months. All patients were then programmed using the full potential of the lead up until 12-months follow-up. RESULTS At six months, there was no significant difference in clinical outcomes whether the SCS was programmed using a mono or a multicolumn program. At 12 months, in all patients having been receiving multicolumn SCS for at least six months (n = 97), VAS decreases were significant for global pain (45.1%), leg pain (55.8%), and BP (41.5%) compared with baseline (p < 0.0001). CONCLUSION The ESTIMET study confirms the significant benefit experienced on chronic BP by patients implanted with multicolumn SCS, independently from multicolumn lead programming. These good clinical outcomes might result from the specific architecture of the multicolumn lead, giving the opportunity to select initially the best column on a multicolumn grid and to optimize neural targeting with low-energy requirements. However, involving more columns than one does not appear necessary, once initial spatial targeting of the "sweet spot" has been achieved. Our findings suggest that this spatial concept could also be transposed to cylindrical leads, which have drastically improved their capability to shape the electrical field, and might be combined with temporal resolution using SCS new modalities.
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Affiliation(s)
- Philippe Rigoard
- PRISMATICS Lab (Predictive Research In Spine/neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France.,Department of Neurosurgery, Spine & Neurostimulation Unit, Poitiers University Hospital, Poitiers, France.,UPR 3346, CNRS, P' Institute, Futuroscope, Faculty of Sciences, Poitiers, France
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research In Spine/neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Pierre Ingrand
- Faculty of Medicine and Pharmacy, Poitiers University Hospital, Poitiers, France
| | | | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research In Spine/neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Philippe Peruzzi
- Department of Neurosurgery, Reims University Hospital, Reims, France
| | - Phong Dam Hieu
- Department of Neurosurgery, Brest University Hospital, Brest, France
| | - Jimmy Voirin
- Department of Neurosurgery, Colmar Hospital, Colmar, France
| | - Sylvie Raoul
- Department of Neurosurgery, Nantes University Hospital, Nantes, France
| | - Philippe Page
- Department of Neurosurgery, Spine & Neurostimulation Unit, Poitiers University Hospital, Poitiers, France
| | | | - Denys Fontaine
- Centre Hospitalier Universitaire de Nice, Department of Neurosurgery, Université Côte d'Azur, Nice, France.,FHU InovPain, Côte Azur University, Nice, France
| | - Michel Lantéri-Minet
- FHU InovPain, Côte Azur University, Nice, France.,Pain Evaluation and Treatment Centre, Nice University Hospital, Nice, France.,INSERM U1107, Neuro-Dol, Trigeminal Pain and Migraine, Auvergne University, Clermont-Ferrand, France
| | - Serge Blond
- Department of Neurosurgery, Lille University Hospital, Lille, France
| | - Nadia Buisset
- Department of Neurosurgery, Lille University Hospital, Lille, France
| | - Emmanuel Cuny
- Department of Neurosurgery, Bordeaux University Hospital, Bordeaux, France
| | - Myriam Cadenne
- Pain Evaluation and Treatment Centre, Bordeaux University Hospital, Bordeaux, France
| | - François Caire
- Department of Neurosurgery, Limoges University Hospital, Limoges, France
| | - Danièle Ranoux
- Pain Evaluation and Treatment Centre, Limoges University Hospital, Limoges, France
| | - Patrick Mertens
- Department of Neurosurgery, Lyon University Hospital, Lyon, France
| | - Hussein Naous
- Department of Neurosurgery, Lyon University Hospital, Lyon, France
| | - Emile Simon
- Department of Neurosurgery, Lyon University Hospital, Lyon, France
| | - Evelyne Emery
- Department of Neurosurgery, Caen University Hospital, Caen, France
| | - Guillaume Béraud
- Internal Medicine/Infectious and Tropical Diseases Department, Poitiers University Hospital, Poitiers, France
| | - Françoise Debiais
- Department of Rheumatology, Poitiers University Hospital, Poitiers, France
| | - Géraldine Durand
- Department of Rheumatology, Poitiers University Hospital, Poitiers, France
| | - Alain Serrie
- Pain Evaluation and Treatment Centre, Lariboisière Hospital, Paris, France
| | - Bakari Diallo
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, Poitiers, France
| | - Julie Bulsei
- Clinical Research Unit in Economics, Hôtel Dieu, Paris, France
| | - Amine Ounajim
- PRISMATICS Lab (Predictive Research In Spine/neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Kevin Nivole
- PRISMATICS Lab (Predictive Research In Spine/neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Sophie Duranton
- Vigilance Department, Clinical Research Direction, Poitiers University Hospital, Poitiers, France
| | - Nicolas Naiditch
- PRISMATICS Lab (Predictive Research In Spine/neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Olivier Monlezun
- PRISMATICS Lab (Predictive Research In Spine/neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Benoit Bataille
- Department of Neurosurgery, Spine & Neurostimulation Unit, Poitiers University Hospital, Poitiers, France
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Schwarm FP, Ott M, Nagl J, Bender M, Stein M, Uhl E, Maxeiner H, Kolodziej MA. The Predictive Value of Transcutaneous Electrical Nerve Stimulation for Patient Selection in Peripheral Nerve Field Stimulation for Chronic Low Back Pain: A Prospective Study. Neuromodulation 2020; 24:1051-1058. [PMID: 32757257 DOI: 10.1111/ner.13244] [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: 04/24/2020] [Revised: 06/10/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Peripheral nerve field stimulation (PNFS) is an effective alternative treatment for patients with chronic low back pain. Transcutaneous electrical nerve stimulation (TENS) is frequently used in pain therapy. Aim of this prospective study was to examine the predictive value of TENS for later PNFS treatment. MATERIALS AND METHODS Between 2014 and 2019, a prospective cohort study of 41 patients with chronic lumbar pain was conducted. Pain intensity (NRS) was assessed before and after TENS use, preoperatively/postoperatively and in the follow-up after three and six months, SF12v2 questionnaires with physical (PCS) and mental component summary (MCS) scores, and Oswestry disability index (ODI) questionnaire at baseline as well as three and six months after PNFS implantation. Implantation of the PNFS-system with two percutaneous leads was performed after four to seven days of positive testing. Statistical analysis was performed using depending t-test, ANOVA, and Spearman correlation. RESULTS The cohort consisted of 41 patients (19 females, 22 males) with a median age of 60.5 years (IQR25-75 52-67). Two patients were lost to follow-up. After positive PNFS testing a pulse generator (IPG) was implanted in 15 patients with positive TENS effect and 15 patients without TENS effect. Leads were explanted in nine patients after negative PNFS trial phase. TENS positive patients showed significant correlation to a positive effect in the PNFS trial phase in NRS reduction (p = 0.042) indicating that TENS responders will also respond to PNFS (94% patients). After three and six months follow-up median NRS and SF12v2 (PCS) improved significantly in both cohorts, SF12v2 (MCS) and ODI only in the TENS positive cohort, respectively. CONCLUSION TENS can be predictive for patient selection in PNFS, as TENS positive patients showed significant correlation with a positive PNFS trial period. Therefore, TENS positive patients might be justifiable to be directly implanted with leads and IPG. TENS positive patients further tend to show a better improvement in the follow-up.
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Affiliation(s)
| | - Marc Ott
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Jasmin Nagl
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Michael Bender
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Marco Stein
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Eberhard Uhl
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Hagen Maxeiner
- Department of Anesthesiology, Intensive Care and Pain Therapy, Justus-Liebig-University Giessen, Giessen, Germany
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Optimizing the Management and Outcomes of Failed Back Surgery Syndrome: A Proposal of a Standardized Multidisciplinary Team Care Pathway. Pain Res Manag 2019; 2019:8184592. [PMID: 31360272 PMCID: PMC6644221 DOI: 10.1155/2019/8184592] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/29/2019] [Accepted: 06/27/2019] [Indexed: 12/17/2022]
Abstract
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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17
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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 Res Manag 2019; 2019:3126464. [PMID: 30911339 PMCID: PMC6398030 DOI: 10.1155/2019/3126464] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/18/2018] [Accepted: 01/26/2019] [Indexed: 12/14/2022]
Abstract
Failed back surgery syndrome (FBSS) is a controversial term for identifying patients affected by new, recurrent, or persistent pain in the low back and/or legs following spinal surgery. The lack of a comprehensive standardized care pathway compromises the appropriate management of FBSS patients, which is associated with a heavy financial burden. An international panel of spine surgeons, neurosurgeons, and pain specialists with a particular interest in FBSS established the chronic back and leg pain (CBLP) network with the aim of addressing the challenges and barriers in the clinical management of FBSS patients by building a common transdisciplinary vision. Based on literature reviews, additional input from clinical expertise of multiple professional disciplines, and consensus among its members, the network attempted to provide recommendations on the management of patients with FBSS utilizing a multidisciplinary team (MDT) approach. The presentation of this work has been divided in two separate parts to enhance its clarity. This first paper, in favour of selecting appropriate validated tools to improve the FBSS patient assessment, focuses on FBSS taxonomy and its clinical implications for evaluation. Concise recommendations for assessment, treatment, and outcome evaluation using a MDT approach would be an important resource for specialists and nonspecialist clinicians who manage patients with FBSS, to improve decision-making, reduce variation in practice, and optimize treatment outcomes in this difficult-to-treat population.
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Affiliation(s)
- Philippe Rigoard
- Spine & Neuromodulation Functional Unit, Poitiers University Hospital, Poitiers, France
- Institut Pprime UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, Poitiers, France
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Kliment Gatzinsky
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jean-Philippe Deneuville
- Spine & Neuromodulation Functional Unit, Poitiers University Hospital, Poitiers, France
- Institut Pprime UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, Poitiers, France
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Wim Duyvendak
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium
| | - Nicolas Naiditch
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Jean-Pierre Van Buyten
- Department of Anesthesia and Pain Management, Hospital AZ Nikolaas, Sint-Niklaas, Belgium
| | - Sam Eldabe
- Department of Pain and Anaesthesia, The James Cook University Hospital, Middlesbrough, UK
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18
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The appropriate management of persisting pain after spine surgery: a European panel study with recommendations based on the RAND/UCLA method. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:31-45. [PMID: 30078053 DOI: 10.1007/s00586-018-5711-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/29/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Management of patients with persisting pain after spine surgery (PPSS) shows significant variability, and there is limited evidence from clinical studies to support treatment choice in daily practice. This study aimed to develop patient-specific recommendations on the management of PPSS. METHODS Using the RAND/UCLA appropriateness method (RUAM), an international panel of 6 neurosurgeons, 6 pain specialists, and 6 orthopaedic surgeons assessed the appropriateness of 4 treatment options (conservative, minimally invasive, neurostimulation, and re-operation) for 210 clinical scenarios. These scenarios were unique combinations of patient characteristics considered relevant to treatment choice. Appropriateness had to be expressed on a 9-point scale (1 = extremely inappropriate, 9 = extremely appropriate). A treatment was considered appropriate if the median score was ≥ 7 in the absence of disagreement (≥ 1/3 of ratings in each of the opposite sections 1-3 and 7-9). RESULTS Appropriateness outcomes showed clear and specific patterns. In 48% of the scenarios, exclusively one of the 4 treatments was appropriate. Conservative treatment was usually considered appropriate for patients without clear anatomic abnormalities and for those with new pain differing from the original symptoms. Neurostimulation was considered appropriate in the case of (predominant) neuropathic leg pain in the absence of conditions that may require surgical intervention. Re-operation could be considered for patients with recurrent disc, spinal/foraminal stenosis, or spinal instability. CONCLUSIONS Using the RUAM, an international multidisciplinary panel established criteria for appropriate treatment choice in patients with PPSS. These may be helpful to educate physicians and to improve consistency and quality of care. These slides can be retrieved under Electronic Supplementary Material.
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Huygen F, Liem L, Cusack W, Kramer J. Stimulation of the L2-L3 Dorsal Root Ganglia Induces Effective Pain Relief in the Low Back. Pain Pract 2017; 18:205-213. [PMID: 28486758 DOI: 10.1111/papr.12591] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/22/2017] [Accepted: 03/28/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Chronic low back pain affects millions of people worldwide and can arise through a variety of clinical origins. In the case of failed back surgery syndrome (FBSS), previous surgical procedures can contribute to low back pain that is often unresponsive to intervention. Although spinal cord stimulation (SCS) can be an effective treatment modality, it does not provide sufficient pain relief for some intractable cases. Recently, alternative neuromodulation options have been developed, including dorsal root ganglion (DRG) stimulation. The objective of this report is to further investigate these clinical observations. METHODS Twelve patients with significant chronic discogenic low back pain due to FBSS were included. All subjects underwent implantation of DRG stimulation systems that had at least 1 lead placed at L2 or L3. Subjects' pain ratings, mood, and quality of life were tracked prospectively for up to 12 months. RESULTS More than half of subjects reported 50% or better pain relief in the low back, and the average low back pain relief was 45.5% at 12 months. Concomitant reductions in overall pain, leg pain, pain interference, mood, and quality of life were also found. DISCUSSION For the studied population, DRG stimulation at the L2-L3 levels was effective at relieving low back pain. These reductions in pain were associated with improvements in quality of life. Thus, DRG stimulation at these levels may be effective for low back pain by recruiting both segmental and nonsegmental neural pathways that are not otherwise accessible via traditional SCS.
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Affiliation(s)
- Frank Huygen
- Erasmus University, Rotterdam, Maastricht, The Netherlands
| | - Liong Liem
- Maastricht University Medical Centre, Maastricht, The Netherlands
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Abstract
Neuropathic pain after spinal surgery, the so-called failed back surgery syndrome (FBSS), is a frequently observed troublesome disease entity. Although medications may be effective to some degree, many patients continue experiencing intolerable pain and functional disability. Only gabapentin has been proven effective in patients with FBSS. No relevant studies regarding manipulation or physiotherapy for FBSS have been published. Spinal cord stimulation (SCS) has been widely investigated as a treatment option for chronic neuropathic pain, including FBSS. SCS was generally accepted to improve chronic back and leg pain, physical function, and sleep quality. Although the cost effectiveness of SCS has been proved in many studies, its routine application is limited considering that it is invasive and is associated with safety issues. Percutaneous epidural adhesiolysis has also shown good clinical outcomes; however, its effects persisted for only a short period. Because none of the current methods provide absolute superiority in terms of clinical outcomes, a multidisciplinary approach is required to manage this complex disease. Further studies concerning the etiology, diagnosis, treatment, and cost effectiveness of FBSS are warranted to deepen our understanding of this condition.
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Abstract
The treatment of failed back surgery syndrome (FBSS) can be equally challenging to surgeons, pain specialists, and primary care providers alike. The onset of FBSS occurs when surgery fails to treat the patient's lumbar spinal pain. Minimizing the likelihood of FBSS is dependent on determining a clear etiology of the patient's pain, recognizing those who are at high risk, and exhausting conservative measures before deciding to go into a revision surgery. The workup of FBSS includes a thorough history and physical examination, diagnostic imaging, and procedures. After determining the cause of FBSS, a multidisciplinary approach is preferred. This includes pharmacologic management of pain, physical therapy, and behavioral modification and may include therapeutic procedures such as injections, radiofrequency ablation, lysis of adhesions, spinal cord stimulation, and even reoperations.
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Affiliation(s)
- Zafeer Baber
- Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Erdek
- Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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22
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Abstract
Failed back surgery syndrome (FBSS) is a term used to define an unsatisfactory outcome of a patient who underwent spinal surgery, irrespective of type or intervention area, with persistent pain in the lumbosacral region with or without it radiating to the leg. The possible reasons and risk factors that would lead to FBSS can be found in distinct phases: in problems already present in the patient before a surgical approach, such as spinal instability, during surgery (for example, from a mistake by the surgeon), or in the postintervention phase in relation to infections or biomechanical alterations. This article reviews the current literature on FBSS and tries to give a new hypothesis to understand the reasons for this clinical problem. The dysfunction of the diaphragm muscle is a component that is not taken into account when trying to understand the reasons for this syndrome, as there is no existing literature on the subject. The diaphragm is involved in chronic lower back and sacroiliac pain and plays an important role in the management of pain perception.
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Affiliation(s)
- Bruno Bordoni
- Department of Cardiology, Foundation Don Carlo Gnocchi, IRCCS, Institute of Hospitalization and Care, S Maria Nascente, Milan, Italy; School CRESO, Osteopathic Centre for Research and Studies, Falconara Marittima, Ancona, Italy
| | - Fabiola Marelli
- School CRESO, Osteopathic Centre for Research and Studies, Falconara Marittima, Ancona, Italy
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A novel, objective, quantitative method of evaluation of the back pain component using comparative computerized multi-parametric tactile mapping before/after spinal cord stimulation and database analysis: The “Neuro-Pain’t” software. Neurochirurgie 2015; 61 Suppl 1:S99-S108. [DOI: 10.1016/j.neuchi.2014.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 08/20/2014] [Accepted: 09/28/2014] [Indexed: 11/19/2022]
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Response to Comments on "Correlation between Radiologic Sign of Lumbar Lordosis and Functional Status in Patients with Chronic Mechanical Low Back Pain". Asian Spine J 2015; 9:151-2. [PMID: 25705350 PMCID: PMC4330213 DOI: 10.4184/asj.2015.9.1.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 01/03/2015] [Indexed: 11/25/2022] Open
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