1
|
Endo T, Kanemura N, Ito T, Sato K, Miura T, Onitsuka K, Miyazawa T, Kubota K, Iwabuchi M, Shirado O. Effect of Residual Pain After Posterior Fusion Surgery for Lumbar Degenerative Disorders on Health-Related Quality of Life: A Two-Year Follow-Up Using Patient-Reported Outcome Measures. Cureus 2024; 16:e61611. [PMID: 38962602 PMCID: PMC11221397 DOI: 10.7759/cureus.61611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 07/05/2024] Open
Abstract
STUDY DESIGN This is a prospective cohort study. PURPOSE The present study aimed to investigate the effects of residual pain after fusion surgery for lumbar degenerative diseases on quality of life (QOL). OVERVIEW OF LITERATURE Residual symptoms after spinal surgery often restrict patients' activities of daily living and reduce their QOL. However, few studies have comprehensively addressed physical, psychological, and social factors. METHODS The study population included a cohort of 208 patients (mean age: 67.9 years) who had undergone posterior interbody fusion for lumbar degenerative disease between 2012 and 2019. We asked the patients to complete the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Short Form Health Survey (SF-36) preoperatively, as well as at six, 12, and 24 months postoperatively. The presence of residual postoperative pain (RPP) was determined using the low back pain score of the JOABPEQ at six months postoperatively, and patients with an improvement of < 20 points compared to preoperative assessment were classified as RPP+ based on a previous study. RESULTS In all patients, there was a notable postoperative improvement in all JOABPEQ and SF-36 domains compared to preoperative scores. The RPP+ group comprised 60 patients (69.6 years), while the RPP- group comprised 148 patients (67.2 years). In the RPP+ group, the lumbar function in the JOABPEQ and general health in the SF-36 showed limited postoperative enhancement. The pace of improvement in the role-emotional, role-physical, social functioning, vitality, and mental health scores was slower in the RPP+ group compared to the RPP- group. CONCLUSIONS In the current study, we found that the presence of residual pain at six months postoperatively affected QOL improvement up to 24 months after surgery. Lingering postoperative pain substantially impacted functional incapacity, social engagement, and psychological well-being. Notably, the lumbar function in the JOABPEQ and general health in the SF-36 showed distinct progression patterns in the RPP+ group.
Collapse
Affiliation(s)
- Tatsuya Endo
- Department of Orthopaedic and Spinal Surgery, and Rehabilitation, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, JPN
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Koshigaya, JPN
| | - Naohiko Kanemura
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Koshigaya, JPN
| | - Toshikazu Ito
- Department of Physical Therapy, Hokkaido Chitose College of Rehabilitation, Chitose, JPN
| | - Keita Sato
- Department of Orthopaedic and Spinal Surgery, and Rehabilitation, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, JPN
| | - Takuya Miura
- Department of Orthopaedic and Spinal Surgery, and Rehabilitation, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, JPN
| | | | - Taku Miyazawa
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Koshigaya, JPN
| | - Keisuke Kubota
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Koshigaya, JPN
| | - Masumi Iwabuchi
- Department of Orthopaedic and Spinal Surgery, and Rehabilitation, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, JPN
| | - Osamu Shirado
- Department of Orthopaedic and Spinal Surgery, and Rehabilitation, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, JPN
| |
Collapse
|
2
|
Soltani A, Ghavipisheh M, Ardakani RM, Ahrari I, Salehi S, Farrokhi MR. Evaluation of the Effect of Repetitive Transcranial Magnetic Stimulation of Motor Cortex on Failed Back Surgery Syndrome Pain Control in the Short Term. J Neurol Surg A Cent Eur Neurosurg 2024; 85:164-170. [PMID: 36528020 DOI: 10.1055/a-2000-6349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study aimed to evaluate the short-term efficacy of repetitive transcranial magnetic stimulation (rTMS) on the treatment of failed back surgery syndrome (FBSS). METHODS In this prospective clinical trial study, 13 patients with FBSS were selected to undergo rTMS, including 5 sessions of stimulation of the primary motor cortex of 90 trains with a frequency of 10 Hz for 2 seconds and an intertrain interval of 20 seconds with a total pulse rate of 1800 per session. The time of each session was 30 minutes with an intensity of 80% of the motor threshold. The severity of pain before and after the intervention was measured by the short-form McGill Pain Questionnaire and visual analog scale (VAS). RESULTS The mean of pain severity was 26.54 ± 6.78 and 14.92 ± 10.1 before and after rTMS, respectively. The severity of pain was significantly decreased after the intervention (p = 0.001). According to the McGill Pain Questionnaire, the severity of pain in the patients was decreased by 44.09 ± 27.32. The mean of the severity of pain according to VAS was 77.31 ± 16.66 before rTMS and 53.46 ± 22.49 after rTMS, which showed that pain intensity was significantly decreased after the intervention (p = 0.006). CONCLUSIONS The use of rTMS of the primary motor cortex in patients who have undergone lumbosacral spine surgery and suffer from pain related to FBSS is associated with a significant reduction in the severity of pain. Because rTMS is a noninvasive treatment method, it can be used as a suitable treatment in these patients.
Collapse
Affiliation(s)
- Ahmad Soltani
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Ghavipisheh
- Department of Psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Manouchehri Ardakani
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iman Ahrari
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sina Salehi
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Reza Farrokhi
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
3
|
Sumitani M, Kimura A, Mochizuki T, Akiyama T, Uranbileg B, Takahashi T, Hirai T, Hayakawa K, Chikuda H, Kurano M. Cerebrospinal Fluid Lysophosphatidylcholine Species for Distinguishing Narrowing of the Lumbar Spine. World Neurosurg 2024; 183:e571-e575. [PMID: 38181872 DOI: 10.1016/j.wneu.2023.12.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Reoperation, sometimes multiple, is common with progressively worse outcomes in patients with degenerative lumbar spine diseases. Lysophosphatidylcholine (LPC), a precursor of lysophosphatidic acid, in the cerebrospinal fluid (CSF) is a possible biomarker for neuropathic pain and discriminating neuropathic pain caused by lumbar spinal canal stenosis (LSCS) from other etiologies. This study aimed to explore this possible use of LPC species in the CSF. METHODS Patients with LSCS (n = 137) and persistent spinal pain syndrome (n = 22) were subjected in this multi-site observational study. The CSF was collected by lumbar puncture. Using liquid chromatography-tandem mass spectrometry, we measured 6 LPC species, (16:0), (18:0), (18:1), (18:2), (20:4), and (22:6), in the CSF. We compared the LPC values between the groups and determined the cutoff levels that could efficiently discriminate the groups with high accuracy. RESULTS The levels of all measured LPC species were significantly higher in the LSCS group than the persistent spinal pain syndrome group. Four LPC species demonstrated more than 0.80 area under the curve obtained from the receiver operating characteristic curve analysis. Although the specificity of cutoff levels for the 6 LPC species was low to moderate, their sensitivity was consistently high. CONCLUSIONS The existing diagnostic protocols combining physical examinations and morphological imaging studies for lumbar spinal pain have limited sensitivity. Measuring LPC species in the CSF is a promising objective laboratory test and could be suitable for detecting the presence of lumbar spinal stenosis and can help indications for surgery.
Collapse
Affiliation(s)
- Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan.
| | - Atsushi Kimura
- Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Takao Mochizuki
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Toru Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Baasanjav Uranbileg
- Department of Clinical Laboratory Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Takuya Takahashi
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Hirai
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kentaro Hayakawa
- Department of Orthopaedics and Spine Surgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Japan
| | - Makoto Kurano
- Department of Clinical Laboratory Medicine, The University of Tokyo Hospital, Tokyo, Japan
| |
Collapse
|
4
|
Kim Y, An SB, Lee SH, Lee JJ, Kim SB, Ahn JC, Hwang DY, Han I. Enhanced Intervertebral Disc Repair via Genetically Engineered Mesenchymal Stem Cells with Tetracycline Regulatory System. Int J Mol Sci 2023; 24:16024. [PMID: 38003216 PMCID: PMC10671788 DOI: 10.3390/ijms242216024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
The therapeutic potential of Mesenchymal stem cells (MSCs) for the treatment of Intervertebral disc (IVD) degeneration can be enhanced by amplifying specific cytokines and proteins. This study aimed to investigate the therapeutic potential of tetracycline-off system-engineered tonsil-derived mesenchymal stem cells (ToMSC-Tetoff-TGFβ1-IGF1-BMP7) for treating intervertebral disc (IVD) degeneration. ToMSCs were isolated from a tonsillectomy patient and genetically modified with four distinct plasmids via CRISPR/Cas9-mediated knock-in gene editing. Transgene expression was confirmed through immunofluorescence, western blots, and an enzyme-linked immunosorbent assay for transforming growth factor beta 1 (TGFβ1) protein secretion, and the effect of MSC-TetOff-TGFβ1-IGF1-BMP7 on disc injury was assessed in a rat model. The ToMSC-Tetoff-TGFβ1-IGF1-BMP7 treatment exhibited superior therapeutic effects compared to ToMSC-TGFβ1, and ToMSC-SDF1α implantation groups, stimulating the regeneration of nucleus pulposus (NP) cells crucial for IVD. The treatment showed potential to restore the structural integrity of the extracellular matrix (ECM) by upregulating key molecules such as aggrecan and type II collagen. It also exhibited anti-inflammatory properties and reduced pain-inducing neuropeptides. ToMSC-Tetoff-TGFβ1-IGF1-BMP7 holds promise as a novel treatment for IVD degeneration. It appears to promote NP cell regeneration, restore ECM structure, suppress inflammation, and reduce pain. However, more research and clinical trials are required to confirm its therapeutic potential.
Collapse
Affiliation(s)
- Yeji Kim
- Research Competency Milestones Program of School of Medicine, CHA University School of Medicine, Seongnam-si 13496, Republic of Korea;
| | - Seong Bae An
- Department of Biomedical Science, Graduate School of CHA University, Seongnam-si 13496, Republic of Korea;
| | - Sang-Hyuk Lee
- Department of Neurosurgery, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam-si 13496, Republic of Korea;
| | - Jong Joo Lee
- Department of Medicine, Graduate School, Kyung Hee University, Seoul 02453, Republic of Korea;
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul 03181, Republic of Korea
| | - Sung Bum Kim
- Department of Neurosurgery, Kyung Hee University, Seoul 02453, Republic of Korea;
| | - Jae-Cheul Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam-si 13496, Republic of Korea
| | - Dong-Youn Hwang
- Department of Neurosurgery, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam-si 13496, Republic of Korea;
- Department of Microbiology, School of Medicine, CHA University, Seongnam-si 13496, Republic of Korea
| | - Inbo Han
- Department of Biomedical Science, Graduate School of CHA University, Seongnam-si 13496, Republic of Korea;
| |
Collapse
|
5
|
Qian M, Li S, Xi K, Tang J, Shen X, Liu Y, Guo R, Zhang N, Gu Y, Xu Y, Cui W, Chen L. ECM-engineered electrospun fibers with an immune cascade effect for inhibiting tissue fibrosis. Acta Biomater 2023; 171:308-326. [PMID: 37673231 DOI: 10.1016/j.actbio.2023.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
Tissue regeneration/fibrosis after injury is intricately regulated by the immune cascade reaction and extracellular matrix (ECM). Dysregulated cascade signal could jeopardize tissue homeostasis leading to fibrosis. Bioactive scaffolds mimicking natural ECM microstructure and chemistry could regulate the cascade reaction to achieve tissue regeneration. The current study constructed an ECM-engineered micro/nanofibrous scaffold using self-assembled nanofibrous collagen and decorin (DCN)-loaded microfibers to regulate the immune cascade reaction. The ECM-engineered scaffold promoted anti-inflammatory and pro-regenerative effects, M2 polarization of macrophages, by nanofibrous collagen. The ECM-engineered scaffold could release DCN to inhibit inflammation-associated fibrous angiogenesis. Yet, to prevent excessive M2 activity leading to tissue fibrosis, controlled release of DCN was expected to elicit M1 activity and achieve M1/M2 balance in the repair process. Regulated cascade reaction guided favorable crosstalk between macrophages, endothelial cells and fibroblasts by proximity. Additionally, decorin could also antagonize TGF-β1 via TGF-β/Smad3 pathway to suppress fibrotic activity of fibroblasts. Hence, ECM-engineered scaffolds could exert effective regulation of the immune cascade reaction by microstructure and DCN release and achieve the balance between tissue fibrosis and regeneration. STATEMENT OF SIGNIFICANCE: With the incidence of up to 74.6%, failed back surgery syndrome (FBSS) has been a lingering issue in spine surgery, which poses a heavy socio-economic burden to society. Epidural fibrosis is believed to be responsible for the onset of FBSS. Current biomaterial-based strategies treating epidural fibrosis mainly rely on physical barriers and unidirectional suppression of inflammation. Regulation of the immune cascade reaction for inhibiting fibrosis has not been widely studied. Based on the simultaneous regulation of M1/M2 polarization and intercellular crosstalk, the ECM-engineered micro/nanofibrous scaffolds constructed in the current study could exert an immune cascade effect to coordinate tissue regeneration and inhibit fibrosis. This finding makes a significant contribution in the development of a treatment for epidural fibrosis and FBSS.
Collapse
Affiliation(s)
- Ming Qian
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006 PR China
| | - Shun Li
- Center for Rehabilitation Medicine, Department of Pain Management, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang 310014, PR China
| | - Kun Xi
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006 PR China
| | - Jincheng Tang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006 PR China
| | - Xiaofeng Shen
- Department of Orthopaedic Surgery, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, 889 Wuzhong West Road, Suzhou, Jiangsu 215006, PR China
| | - Yong Liu
- Department of Orthopaedic Surgery, Affiliated Jiangyin Hospital of Nantong University, Jiangyin, Jiangsu 215600, PR China
| | - Ran Guo
- Center for Rehabilitation Medicine, Department of Pain Management, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang 310014, PR China
| | - Nannan Zhang
- Center for Rehabilitation Medicine, Department of Pain Management, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang 310014, PR China
| | - Yong Gu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006 PR China.
| | - Yun Xu
- Center for Rehabilitation Medicine, Department of Pain Management, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang 310014, PR China.
| | - Wenguo Cui
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, PR China.
| | - Liang Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006 PR China.
| |
Collapse
|
6
|
Lee D, Cha B, Kim J, Choi YS, Kim M, Han I, Min K. Paraspinal muscles atrophy on both sides and at multiple levels after unilateral lumbar partial discectomy. Medicine (Baltimore) 2023; 102:e32688. [PMID: 36701703 PMCID: PMC9857383 DOI: 10.1097/md.0000000000032688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
To identify the changes in cross-sectional areas (CSAs) and fatty infiltration of both sides of the paravertebral muscles and their associations with prognostic factors in patients who underwent unilateral lumbar discectomy. We retrospectively reviewed 27 patients who underwent magnetic resonance imaging before and after 1- or 2-level lumbar discectomy. The CSAs and functional cross-sectional areas of the paraspinal muscles were bilaterally measured from L1 to L2 to L5 to S1 based on T2-weighted axial images. These parameters were compared pre-and postoperatively. CSAs and functional cross-sectional areas decreased also in non-operative, non-surgical levels, not only in operated levels after discectomy. In the correlation analysis, the CSA of psoas major muscle at L1 to L2 was significantly decreased in patients with lower preoperative lordosis (r = 0.598, P = .040). The postoperative CSA of psoas major muscle at L4 to L5 was lower in those with the higher Pfirrmann grade (r = -0.590, P = .002); however, the CSA of quadratus lumborum muscle at L1 to L2 showed the opposite result (r = 0.526, P = .036). Similar results were also observed in the partial correlation adjusted for age and postoperative duration. Patients who underwent discectomy experienced overall paraspinal muscle atrophy in the lumbar region, including surgical and non-surgical sites. Such atrophic changes emphasized the need for core strengthening and lumbar rehabilitation from the early period after partial discectomy.
Collapse
Affiliation(s)
- Doyoung Lee
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Byungwoo Cha
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jongwook Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Yong-Soo Choi
- Department of Biotechnology, CHA University, Seongnam, Korea
| | - MinYoung Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Inbo Han
- Department of Neurosurgery, Spine Center, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
- * Correspondence: Kyunghoon Min, Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Korea (e-mail: )
| |
Collapse
|
7
|
Mesregah MK, Mgbam P, Fresquez Z, Wang JC, Buser Z. Impact of chronic hyperlipidemia on perioperative complications in patients undergoing lumbar fusion: a propensity score matching analysis. 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 2022; 31:2579-2586. [PMID: 35932331 DOI: 10.1007/s00586-022-07333-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/15/2022] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Lumbar fusion is widely used to treat degenerative and traumatic conditions of the spine, with various perioperative complications. This study compared lumbar fusion complications in patients with and without chronic hyperlipidemia. METHODS Using the MSpine division of the PearlDiver database, patients with or without chronic hyperlipidemia who underwent lumbar fusions were identified. The appropriate Current Procedural Terminology (CPT) codes identified patients with single- or multi-level lumbar spinal fusion surgeries. International Classification of Diseases (ICD-9 and ICD-10) codes identified patients with chronic hyperlipidemia. The surgical and medical complications were obtained utilizing the appropriate ICD-9, ICD-10, and CPT codes. Propensity score matching analysis was used to control for confounding factors. Chi-square test was applied to compare the incidence of complications among different groups. RESULTS In single-level fusion group, patients with hyperlipidemia had a higher incidence of wound complications (P < 0.001), surgical site infection (P < 0.001), failed back syndrome (P < 0.001), hardware removal (P < 0.001), deep venous thrombosis/pulmonary embolism (P = 0.031), myocardial infarction (P < 0.001) cerebrovascular accident (P < 0.001), renal failure (P < 0.001), sepsis (P < 0.001), and urinary tract infection/incontinence (P < 0.001). In multi-level fusion group, patients with hyperlipidemia had a higher incidence of nerve root injury (P = 0.034), wound complications (P < 0.001), surgical site infection (P < 0.001), failed back syndrome (P < 0.001), hardware removal (P < 0.001), revision (P = 0.002), myocardial infarction (P < 0.001), renal failure (P < 0.001), and urinary tract infection/incontinence (P < 0.001). CONCLUSION Following lumbar fusion, patients with chronic hyperlipidemia have an increased risk of perioperative complications, including wound complications, surgical site infection, failed back surgery syndrome, hardware removal, myocardial infarction, renal failure, and urinary tract infection/incontinence.
Collapse
Affiliation(s)
- Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Paul Mgbam
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Zoe Fresquez
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA.
- Gerling Institute, Brooklyn, USA.
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, USA.
| |
Collapse
|
8
|
Vu TN, Khunsriraksakul C, Vorobeychik Y, Liu A, Sauteraud R, Shenoy G, Liu DJ, Cohen SP. Association of Spinal Cord Stimulator Implantation With Persistent Opioid Use in Patients With Postlaminectomy Syndrome. JAMA Netw Open 2022; 5:e2145876. [PMID: 35099546 PMCID: PMC8804916 DOI: 10.1001/jamanetworkopen.2021.45876] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The results of studies evaluating spinal cord stimulation (SCS) for postlaminectomy syndrome (PLS) have yielded mixed results. This has led to an increased emphasis on objective outcome measures such as opioid prescribing. OBJECTIVE To determine the association between SCS and long-term opioid therapy (LOT) for PLS. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, adults with PLS were identified using the TriNetx Diamond Network and separated based on whether they underwent SCS. Patients were stratified according to baseline opioid use (opioid-naive or receiving LOT) and subsequent opioid therapy over the 12-month period ranging from 3 to 15 months post-SCS implantation or post-PLS index date. Statistical analysis was performed from June to December 2021. EXPOSURE SCS. MAIN OUTCOMES AND MEASURES The main outcome was cessation of opioid use among patients receiving LOT or abstinence from opioids among opioid-naive patients. Opioid-naive patients were defined as those receiving at most 2 opioid prescriptions per year, and patients on LOT were those receiving at least 6 opioid prescriptions per year. RESULTS Among 552 937 eligible patients treated between December 2015 and May 2021, 26 179 with PLS received an SCS implant. The median (IQR) patient age was 60 (51-69) years; 305 802 patients (55.3%) were female. Among those reporting racial identify (37.0% [204 758 patients]), 9.3% (18 971 patients) were African American, 0.3% (648 patients) were Asian, and 90.4% (185 139 patients) were White. Compared with those who did not receive an SCS, individuals who received an SCS were more likely to be using opioids preimplantation (mean [SD] prescriptions: 4.3 [8.5] vs 4.1 [9.3]; P < .001) but less likely to be using opioids after SCS implantation (mean [SD] prescriptions: 3.8 [8.2] vs 4.0 [9.4]; P = .006). In the 12-month study period, similar proportions in the SCS and no-SCS groups receiving baseline LOT remained on LOT (70.3% [n = 74 585] vs 69.2% [n = 3882], respectively; P = .10). In opioid-naive patients, SCS was associated with a small decreased likelihood of patients subsequently receiving LOT (7.6% vs 7.0%; difference, -0.6% [95% CI, -1.0% to -0.2%]; P = .003). In multivariable analysis, SCS was associated with an increased likelihood of not being on opioids in both opioid-naive (adjusted odds ratio [OR], 0.90 [95% CI, 0.85-0.96]; P < .001) and LOT patients (adjusted OR, 0.93 [95% CI, 0.88-0.99]; P = .02). White patients were significantly more likely to be diagnosed with PLS (ie, underwent surgery) (90.4% vs 85.2%; difference, 5.2% [95% CI, 5.1%-5.4%]; P < .001) and receive an SCS (93.7% vs 90.3%; difference, 3.4% [95% CI, 2.9% to 4.0%]; P < .001) than patients of other racial identities. CONCLUSIONS AND RELEVANCE These findings suggest that under real-life conditions, SCS was associated with small, clinically questionable associations with opioid discontinuation and not starting opioids in the context of PLS.
Collapse
Affiliation(s)
- To-Nhu Vu
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Yakov Vorobeychik
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Alison Liu
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Renan Sauteraud
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ganesh Shenoy
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Dajiang J. Liu
- Departments of Public Health Sciences and Biochemistry & Molecular Biology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Steven P. Cohen
- Departments of Anesthesiology and Critical Care Medicine, Physical Medicine & Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
- Departments of Anesthesiology and Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| |
Collapse
|
9
|
Evaluation of the reduction, tightening and gripping performance of an innovative set screw technology for instrumented posterior lumbar fusion: A biomechanical study. Orthop Traumatol Surg Res 2021; 107:102918. [PMID: 33812093 DOI: 10.1016/j.otsr.2021.102918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Instrumented posterior lumbar fusion with top-loading pedicle screw systems (PSS) requires fully tightened set screws to achieve a secure fixation and symmetric load condition. This assumes a complete reduction of the rod by 90°, which is not always attainable in situ, especially under constraint. The objective of this work is to compare the mechanical performance of different innovative set screw technologies, which should improve the tightening process. HYPOTHESIS The hypotheses of the study are that modifications to the screw and screwdriver unit can (1) improve the quality of set screw tightening and (2) increase the axial gripping capacity of the construct. MATERIALS AND METHODS The four set screw technologies under investigation include a standard set screw with a flat surface (F-S; control group), a set screw with a convex surface (C-S) and a shaft tip method screwdriver used in combination with both flat (F-STM) and convex set screws (C-STM). The quality of set screw tightening is categorized as follows: failed=the rod is not completely reduced; reduced=the rod is successfully reduced but the set screw is not correctly fixed; good=remaining cases. An axial gripping capacity test is performed by a universal testing machine (Instron®) with a force capacity of 5kN. RESULTS Regarding the quality of set screw tightening, comparisons between F-S vs. F-STM, F-S vs. C-STM and between C-S vs. C-STM show statistically significant differences (p<0.001). The axial gripping capacity test shows mean gripping forces of 1223N (STD 331) in the F-STM group and of 1724N (STD 168) in the C-STM group with statistically significant differences between both groups (p=0.003). DISCUSSION Several biomechanical and clinical case studies have identified possible effects of misaligned rod-screw interfaces such as screw pull-out during rod reduction, screw loosening, screw or rod breakage, misalignment, adjacent segment degeneration and worsening of the clinical outcome. C-STM-technology thus supports controlled fixation in the sense of applying appropriate forces for correction or fixation during PSS assembly as well as friction-reduced final alignment and tightening with the aim to reduce implant loosening, hardware failure and reoperations, while respecting anatomical and biomechanical balance.
Collapse
|
10
|
Nissen M, Ikäheimo TM, Huttunen J, Leinonen V, Jyrkkänen HK, von Und Zu Fraunberg M. Gabapentinoids Associated With Lower Explantation Rate in 203 Patients With Spinal Cord Stimulation for Failed Back Surgery Syndrome. Neurosurgery 2021; 89:626-634. [PMID: 34270731 PMCID: PMC8632751 DOI: 10.1093/neuros/nyab242] [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: 11/17/2020] [Accepted: 05/08/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Spinal cord stimulation (SCS) is an effective treatment in failed back surgery syndrome (FBSS). The effect of neuropathic pain medication use on SCS outcome is poorly understood. OBJECTIVE To study the effect of gabapentinoid use on SCS outcome measured by trial success, explantation rate and opioid dose reduction during a 2-yr follow-up. METHODS The study cohort included 203 consecutive FBSS patients who underwent SCS in a single tertiary center during January 1997 to March 2014. Purchase data of gabapentinoids, opioids, tricyclic antidepressants, serotonin and noradrenaline reuptake inhibitors, and benzodiazepines during January 1995 to March 2016 were retrieved from national registries. RESULTS In multivariate Cox regression analysis, patients using gabapentinoids had significantly fewer explantations during the 2-yr follow-up (hazard ratio [HR] 0.2, 95% CI 0.04-0.81, P = .03). In contrast, patients with opioid use of >40 morphine milligram equivalent before implantation had significantly more explantations (HR 6.7, 95% CI 2.5-18, P < .01). In bivariate logistic regression analysis adjusted for patient specific factors, year of SCS implantation, use of neuropathic pain medication, opioids, and benzodiazepines, patients using gabapentinoids significantly more often discontinued opioids or reduced their dose by more than 50% during the 2-yr follow-up (odds ratio 5.7, 95% CI 1.4-23, P = .015). CONCLUSION The use of gabapentinoids was associated with a significantly lower spinal cord stimulator explantation rate and a higher chance of opioid discontinuation or >50% dose reduction. This indicates that patients with SCS could benefit from concomitant use of gabapentinoids. Prospective randomized trials are warranted to verify this hypothesis.
Collapse
Affiliation(s)
- Mette Nissen
- Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Faculty of Health Sciences, School of Medicine Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland
| | - Tiina-Mari Ikäheimo
- Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Jukka Huttunen
- Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Ville Leinonen
- Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Faculty of Health Sciences, School of Medicine Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland
| | | | - Mikael von Und Zu Fraunberg
- Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Faculty of Health Sciences, School of Medicine Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
11
|
Deer TR, Gilmore CA, Desai MJ, Li S, DePalma MJ, Hopkins TJ, Burgher AH, Spinner DA, Cohen SP, McGee MJ, Boggs JW. Percutaneous Peripheral Nerve Stimulation of the Medial Branch Nerves for the Treatment of Chronic Axial Back Pain in Patients After Radiofrequency Ablation. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:548-560. [PMID: 33616178 PMCID: PMC7971467 DOI: 10.1093/pm/pnaa432] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Lumbar radiofrequency ablation is a commonly used intervention for chronic back pain. However, the pain typically returns, and though retreatment may be successful, the procedure involves destruction of the medial branch nerves, which denervates the multifidus. Repeated procedures typically have diminishing returns, which can lead to opioid use, surgery, or implantation of permanent neuromodulation systems. The objective of this report is to demonstrate the potential use of percutaneous peripheral nerve stimulation (PNS) as a minimally invasive, nondestructive, motor-sparing alternative to repeat radiofrequency ablation and more invasive surgical procedures. DESIGN Prospective, multicenter trial. METHODS Individuals with a return of chronic axial pain after radiofrequency ablation underwent implantation of percutaneous PNS leads targeting the medial branch nerves. Stimulation was delivered for up to 60 days, after which the leads were removed. Participants were followed up to 5 months after the start of PNS. Outcomes included pain intensity, disability, and pain interference. RESULTS Highly clinically significant (≥50%) reductions in average pain intensity were reported by a majority of participants (67%, n = 10/15) after 2 months with PNS, and a majority experienced clinically significant improvements in functional outcomes, as measured by disability (87%, n = 13/15) and pain interference (80%, n = 12/15). Five months after PNS, 93% (n = 14/15) reported clinically meaningful improvement in one or more outcome measures, and a majority experienced clinically meaningful improvements in all three outcomes (i.e., pain intensity, disability, and pain interference). CONCLUSIONS Percutaneous PNS has the potential to shift the pain management paradigm by providing an effective, nondestructive, motor-sparing neuromodulation treatment.
Collapse
Affiliation(s)
- Timothy R Deer
- Spine and Nerve Center of the Virginias, Charleston, West Virginia, USA
| | | | - Mehul J Desai
- International Spine Pain and Performance Center, George Washington University, School of Medicine, Washington, DC, USA
| | - Sean Li
- Premier Pain Centers, Shrewsbury, New Jersey, USA
| | | | | | | | | | - Steven P Cohen
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | |
Collapse
|
12
|
Salik E, Donat A, Ağaoğlu MH. Chiropractic Nimmo Receptor-Tonus Technique and McKenzie Self-Therapy Program in the Management of Adjacent Segment Disease: A Case Report. J Chiropr Med 2021; 19:249-259. [PMID: 33536862 DOI: 10.1016/j.jcm.2020.01.002] [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: 11/06/2018] [Revised: 09/20/2019] [Accepted: 01/29/2020] [Indexed: 11/30/2022] Open
Abstract
Objective The objective of the present study objective was to describe adjacent segment disease (ASD) from a chiropractic management prospective and subsequently to stimulate further research into the chiropractic therapeutic effects on such cases and to contribute to chiropractic literature. Clinical Features A 44-year-old woman had a history of lumbar stabilization revision operation by pedicle screw fixation for spondylolisthesis. Her intractable back pain episodes, which were diagnosed as ASD, began shortly after this surgery. At presentation, she was taking pregabalin 75 mg 2 times a day for postoperative neuropathic pain without any pain relief. Clinical testing revealed myofascial tender points reproducing the pain. Intervention and Outcome After taking the case history and performing a physical examination, the patient was managed with chiropractic Nimmo receptor-tonus technique in combination with McKenzie exercises. Nimmo was applied by manually pressing on clinically relevant points for 5 to 15 seconds in 11 visits over 3 weeks. The patient by herself did McKenzie exercises 5 to 10 times a day for 10 to 12 repetitions over 2 months. After 3 weeks of therapy, visual analog scale and Oswestry Disability Index scores were improved. Furthermore, because of the amelioration of the patient's symptoms, her neurosurgeon successfully discontinued pregabalin 75 mg 2 times a day without negative consequences to care. Conclusion As far as the authors are aware, there is currently no published case of ASD care in chiropractic literature. Our rehabilitative management received a favorable response. It can be hypothesized that it offers a perspective that informs improved patient care.
Collapse
Affiliation(s)
- Emsal Salik
- Chiropractic Program, Health Sciences Institute, Bahcesehir University, Besiktas, Istanbul, Turkey
| | - Ali Donat
- Chiropractic Program, Health Sciences Institute, Bahcesehir University, Besiktas, Istanbul, Turkey
| | - Mustafa Hulisi Ağaoğlu
- Chiropractic Program, Health Sciences Institute, Bahcesehir University, Besiktas, Istanbul, Turkey
| |
Collapse
|
13
|
The dimensions of "failed back surgery syndrome": what is behind a label? Acta Neurochir (Wien) 2021; 163:245-250. [PMID: 32875358 DOI: 10.1007/s00701-020-04548-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The term failed back surgery syndrome (FBSS) has been criticized for being too unspecific and several studies have shown that a variety of conditions may underlie this label. The aims of the present study were to describe the specific symptoms and to investigate the primary and secondary underlying causes of FBSS in a contemporary series of patients who had lumbar spinal surgery before. METHODS We used a multilevel approach along three different axes defining symptomatic, morphological, and functional pathology dimensions. RESULTS Within the study period of 3 years, a total of 145 patients (74 f, 71 m, mean age 51a, range 32-82a) with the external diagnosis of FBSS were included. Disk surgery up to 4 times and surgery for spinal stenosis up to 3 times were the commonest index operations. Most often, the patients complained of low back pain (n = 126), pseudoradicular pain (n = 54), and neuropathic pain (n = 44). Imaging revealed osteochondrosis (n = 61), spondylarthrosis (n = 48), and spinal misalignment (n = 32) as the most frequent morphological changes. The majority of patients were assigned at least to two different symptomatic subcategories and morphological subcategories, respectively. According to these findings, one or more functional pathologies were assigned in 131/145 patients that subsequently enabled a specific treatment strategy. CONCLUSIONS FBSS has become rather a vague and imprecisely used generic term. We suggest that it should be avoided in the future both with regard to its partially stigmatizing connotation and its inherent hindering to provide individualized medicine.
Collapse
|
14
|
Daniels CJ, Cupler ZA, Gliedt JA, Walters S, Schielke AL, Hinkeldey NA, Golley DJ, Hawk C. Manipulative and manual therapies in the management of patients with prior lumbar surgery: A systematic review. Complement Ther Clin Pract 2020; 42:101261. [PMID: 33276229 DOI: 10.1016/j.ctcp.2020.101261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/12/2020] [Accepted: 11/12/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Pain and disability may persist following lumbar spine surgery and patients may subsequently seek providers trained in manipulative and manual therapy (MMT). This systematic review investigates the effectiveness of MMT after lumbar surgery through identifying, summarizing, assessing quality, and grading the strength of available evidence. Secondarily, we synthesized the impact on medication utilization, and reports on adverse events. METHODS Databases and grey literature were searched from inception through August 2020. Article extraction consisted of principal findings, pain and function/disability, medication consumption, and adverse events. RESULTS Literature search yielded 2025 articles,117 full-text articles were screened and 51 citations met inclusion criteria. CONCLUSION There is moderate evidence to recommend neural mobilization and myofascial release after lumbar fusion, but inconclusive evidence to recommend for or against most manual therapies after most surgical interventions. The literature is primarily limited to low-level studies. More high-quality studies are needed to make recommendations.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Cheryl Hawk
- Texas Chiropractic College, Pasadena, TX, USA
| |
Collapse
|
15
|
Gilmore CA, Kapural L, McGee MJ, Boggs JW. Percutaneous Peripheral Nerve Stimulation for Chronic Low Back Pain: Prospective Case Series With 1 Year of Sustained Relief Following Short-Term Implant. Pain Pract 2020; 20:310-320. [PMID: 31693791 PMCID: PMC7079182 DOI: 10.1111/papr.12856] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Percutaneous peripheral nerve stimulation (PNS) provides an opportunity to relieve chronic low back pain and reduce opioid analgesic consumption as an alternative to radiofrequency ablation and permanently implanted neurostimulation systems. Traditionally, the use of neurostimulation earlier in the treatment continuum has been limited by its associated risk, invasiveness, and cost. METHODS Percutaneous PNS leads (SPRINT MicroLead) were placed bilaterally to target the medial branches of the dorsal rami nerves under image guidance. The percutaneous leads were connected to miniature wearable stimulators (SPRINT PNS System) for the 1-month therapy period, after which the leads were removed. Pain and disability were assessed long-term up to 12 months after lead removal. RESULTS Substantial, clinically significant reductions in average pain intensity (≥50% reduction as measured by the Brief Pain Inventory Short Form) were experienced by a majority of subjects (67%) at end of treatment compared to baseline (average 80% reduction among responders; P < 0.05, analysis of variance; n = 9). Twelve months after the end of PNS treatment, a majority of subjects who completed the long-term follow-up visits experienced sustained, clinically significant reductions in pain and/or disability (67%, n = 6; average 63% reduction in pain intensity and 32-point reduction in disability among responders). No serious or unanticipated adverse events were reported. CONCLUSIONS This study challenges the long-held notion that a positive trial of PNS should be followed by a permanent implant in responders. Percutaneous PNS may serve as an effective neurostimulation therapy for patients with chronic low back pain and should be considered earlier in the treatment continuum as a motor-sparing means of avoiding opioids, denervation, and permanently implanted neurostimulation systems.
Collapse
Affiliation(s)
| | - Leonardo Kapural
- Center for Clinical ResearchCarolinas Pain InstituteWinston SalemNorth CarolinaU.S.A.
| | | | | |
Collapse
|
16
|
Sferopoulos NK. Neurogenic hallux valgus. A rare complication of spinal surgery. J Bodyw Mov Ther 2019; 23:448-451. [PMID: 31563353 DOI: 10.1016/j.jbmt.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Post-surgical lumbar spine syndrome is the result of failed or unsuccessful back surgery. It is defined as failure to relieve pain and disability in the lower back and extremities following surgery. This case report suggests inclusion of neurogenic hallux valgus to the list of potential complications following failed lumbar spine surgery. CASE REPORT A severe unilateral hallux valgus deformity with an irreducible dislocation of the metatarsophalangeal joint due to complete wasting of the abductor hallucis muscle was diagnosed in a 73-year-old woman admitted for a hip fracture. The patient reported that the deformity developed after a failed lumbar spine surgery, which included decompression and stabilization of L2-S1 with posterior instrumentation 6 years previously. The deformity progressively deteriorated over a 3-year-period. Three months following the hip fracture surgery, the patient went through a neurological examination and an electrophysiological study. The findings indicated that the left hallux valgus deformity most likely developed because of the abductor hallucis muscle wasting due to S1 nerve root injury secondary to the failed lumbar spine surgery. CONCLUSION Post-surgical lumbar spine syndrome may be a reasonable causative etiology of a severe unilateral hallux valgus deformity with an irreducible dislocation of the metatarsophalangeal joint due to complete wasting of the abductor hallucis muscle secondary to S1 nerve root injury.
Collapse
Affiliation(s)
- N K Sferopoulos
- 2nd Department of Orthopaedic Surgery, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, 546 35, Thessaloniki, Greece.
| |
Collapse
|
17
|
Genov PG, Timerbaev VK, Dolgasheva NS, Efanov AA, Grin' AA, Rebrova OY. [The effect of various multimodal analgesia regimens during surgical treatment of patients with spinal stenosis on the rate of failed back surgery syndrome]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 83:71-79. [PMID: 31166320 DOI: 10.17116/neiro20198302171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the effect of various methods of perioperative analgesia on the rate of failed back surgery syndrome in patients operated on for spinal stenosis. MATERIAL AND METHODS A total of 122 patients were operated on for spinal stenosis in 2010-2016. The patients were assigned to groups according to the type of received analgesia: Group K (n=19) underwent analgesia on-demand. Patients in the PMA group (n=21) received preventive multimodal analgesia (PMA) with ketoprofen, paracetamol and morphine. Patients in the PMA+PG (n=20) and PMA+N (n=20) groups additionally received pregabalin and nefopam, respectively. Patients in the PMA+E group (n=22) received continuous epidural analgesia with a combination of ropivacaine and morphine. In patients in the PMA+I group (n=20), the wound was infiltrated with ropivacaine and ketorolac. RESULTS AND CONCLUSION In Group K, analgesia was not adequate during five postoperative days. Analgesia with PMA resulted in significant pain reduction during three postoperative days compared to Group K. Wound infiltration in addition to PMA was followed by more significant pain relief during six postoperative hours (compared to the PMA group). Administration of pregabalin or nefopam, as well as epidural analgesia, did not improve quality of postoperative analgesia. Five to seven months after the surgery, 66% (57; 75%) of patients had low back and/or leg pain; 41% (32; 50%) of patients had leg pain. Among patients suffering from pain, 32-41% patients had the severe chronic pain syndrome that resulted in sleep disorder, disability and significant deterioration of quality of life. The rate of failed back surgery syndrome did not depend on the perioperative analgesia regimen.
Collapse
Affiliation(s)
- P G Genov
- Sklifosovsky Research Institute of Emergency Care, Moscow Healthcare Department, Moscow, Russia
| | - V Kh Timerbaev
- Sklifosovsky Research Institute of Emergency Care, Moscow Healthcare Department, Moscow, Russia
| | - N S Dolgasheva
- Sklifosovsky Research Institute of Emergency Care, Moscow Healthcare Department, Moscow, Russia
| | - A A Efanov
- Sklifosovsky Research Institute of Emergency Care, Moscow Healthcare Department, Moscow, Russia
| | - A A Grin'
- Sklifosovsky Research Institute of Emergency Care, Moscow Healthcare Department, Moscow, Russia
| | - O Yu Rebrova
- Pirogov Russian National Research Medical University, Ministry of Health of the Russia, Moscow, Russia
| |
Collapse
|
18
|
Dextrose injections for failed back surgery syndrome: a consecutive case series. 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 2019; 28:1610-1617. [PMID: 31115685 DOI: 10.1007/s00586-019-06011-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/13/2019] [Accepted: 05/13/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Patients with chronic low back pain, who do not respond to conservative treatment methods, generally undergo surgical revision operations, and sometimes an undesirable condition called failed back surgery syndrome (FBSS) may be inevitable. Hereby, dextrose is one of the regenerative methods that has gained popularity in the treatment of many musculoskeletal problems, and we aimed to present and evaluate the outcomes of 5% dextrose for the treatment of FBSS. METHODS It has been designed as a consecutive case series. A total of 79 patients with FBSS, who had minimum 6 months of symptoms and did not respond to 3 months of conservative methods between May 2014 and March 2016, participated in the study. Prolotherapy injections were applied in posterior and lateral approaches. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were used for the pre- and post-treatment evaluations. Patient satisfaction was assessed with using a 5-point Likert scale by phone contacting. RESULTS There was statistically significant difference between repeated VAS and ODI measurements. CONCLUSIONS These results may be the first step giving a lead to an undiscovered field. This treatment method should be kept in mind for FBSS patients before giving a decision of revision surgery. These slides can be retrieved under Electronic Supplementary Material.
Collapse
|
19
|
Evaluating the Quality, Content, and Readability of Online Resources for Failed Back Spinal Surgery. Spine (Phila Pa 1976) 2019; 44:494-502. [PMID: 30234809 DOI: 10.1097/brs.0000000000002870] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN An Internet-based assessment of websites using recognized score systems. OBJECTIVE To assess the quality, content, and readability of online information for failed back spinal surgery (FBSS). SUMMARY OF BACKGROUND DATA A significant amount of patients still suffer from chronic or recurrent back pain with or without radicular symptoms after spinal surgery. More and more patients use the Internet to find health-related information. Low-quality or inaccurate information may not only misleading patients but also have a negative impact on the trust between patients and physicians. METHODS The terms "chronic pain after spinal surgery," "chronic pain after back surgery," "failed back surgery syndrome," "post spinal surgery syndrome," and "post laminectomy syndrome" were entered into three search engines (Google, Yahoo!, and Bing). The first 25 websites from each search were reviewed. The quality, content, and readability of each website were evaluated using DISCERN score, FBSS-specific content score, and the Journal of the American Medical Association (JAMA) benchmark criteria, the first two score systems were assessed by three reviewers independently. The Flesch-Kincaid grade level (FKGL) was used to assess the readability. Each website with or without the Health on the Net Code (HONcode) was also recorded. RESULTS Seventy-two websites were analyzed in our study. The average DISCERN score for all websites was 35.26 ± 11.45, indicating the quality of the websites was poor. The DISCERN score of physician websites was 31.25 ± 9.08, lower than that of media (36.50 ± 0.71, P = 0.017) and commercial websites (42.55 ± 10.93, P = 0.045). The mean FBSS-specific content score was 9.58 ± 3.90 out of maximum 25. We failed to find any difference of FBSS-specific content score among different type of website. Websites with HONcode certification were associated with higher DISCERN score, FBSS-specific content score, and JAMA benchmark criteria score than non-certified websites. The mean FKGL was 12.19 ± 2.20, and none of the websites' FKGL was lower than the six grade level. CONCLUSION The quality and content of available online information for FBSS were poor. The readability of online information in our results showed a significantly higher reading level than the sixth-grade level recommended by the AMA and NIH. LEVEL OF EVIDENCE 4.
Collapse
|
20
|
Ishak B, Campos B, Brunn H, Unterberg AW, Ahmadi R. Feasibility, Safety, and Efficacy of Subcutaneous Peripheral Nerve Field Stimulation for the Treatment of Refractory Low Back Pain: A Two-year Single-center Study. Neuroscience 2018; 387:38-47. [PMID: 29248528 DOI: 10.1016/j.neuroscience.2017.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 11/19/2022]
Abstract
Chronic low back pain (CLBP) is challenging to treat. Minimal invasive neurostimulation therapies, such as subcutaneous peripheral nerve field stimulation (SPNS), improve pain relief and quality of life. The goal of the present study was to assess the usefulness, safety, and efficacy of SPNS in patients with CLBP. Twenty-six consecutive patients with CLBP were prospectively included in the study. For trial neurostimulation, two electrodes were implanted vertically at a depth of 1 cm into the subcutaneous tissue, ≤10 cm from the region of maximum pain. Trial neurostimulation was performed in all patients for 14 days. A successful outcome was defined as at least 50% pain relief. To monitor the effects of permanent neurostimulation, the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), and quality of life (EQ-5D-3L) were scored preoperatively and at 6-month and 24-month follow-ups. Thirteen patients responded to trial stimulation and had a permanent neurostimulator implanted. The use of pain medication, including opioid analgesics, was reduced in 92% of patients after 24 months. VAS, ODI, and EQ-5D-3L scores were significantly improved in these patients at the 24-month follow-up. The complication rate was 23% (3/13 patients). In non-responders, VAS and ODI at 24 months dropped significantly as well but the decrease was less pronounced compared to responders and had not led to a decrease in pain medication. SPNS is a novel, safe, and effective treatment for CLBP and may have advantages over interventional treatments including intrathecal therapy and spinal cord stimulation.
Collapse
Affiliation(s)
- Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Benito Campos
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Heike Brunn
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas W Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Rezvan Ahmadi
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
| |
Collapse
|
21
|
Koh W, Kang K, Lee YJ, Kim MR, Shin JS, Lee J, Lee JH, Shin KM, Ha IH. Impact of acupuncture treatment on the lumbar surgery rate for low back pain in Korea: A nationwide matched retrospective cohort study. PLoS One 2018; 13:e0199042. [PMID: 29894499 PMCID: PMC5997340 DOI: 10.1371/journal.pone.0199042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/30/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Low back pain (LBP) is a globally prevalent disorder with high social significance. Invasive surgical procedures are increasingly being used to treat LBP despite a lack of solid evidence supporting their long-term benefits. This nationwide retrospective cohort study investigated the association between acupuncture treatment and lumbar surgery rate in patients with LBP. METHODS Using the National Health Insurance Service Sample Cohort Database for 2002-2013, we identified newly diagnosed LBP patients in Korea between 2004 and 2010 and divided them into an acupuncture group and control group according to whether or not they received acupuncture. Propensity scores based on age, sex, income, and Charlson Comorbidity Index were matched between the two study groups. The lumbar surgery rate in the two years following the first visit (control group) or the first acupuncture session (acupuncture group) was calculated. In addition to the overall analysis, stratified analyses were also conducted in different age, sex, and income strata. Sensitivity analyses were further performed using varying definitions of acupuncture treatment. RESULTS After matching, 130,089 subjects were included in each study group. The lumbar surgery rate was significantly lower in the acupuncture group than in the control group (hazard ratio [HR] 0.633, 95% confidence interval [CI] 0.576-0.696). Decrease in HR was consistently observed in the acupuncture group for all age strata, except for patients in their 20s (HR 1.031, 95% CI 0.804-1.323). HR for lumbar surgery tended to be further reduced in the older age groups upon acupuncture treatment, with no apparent sex-related differences. Lowered HR in the acupuncture group was continuously observed across all income groups; the higher income group showed a tendency of greater decrease. Sensitivity analyses showed that the number of acupuncture sessions had no major impact on the likelihood of lumbar surgery, but also that more intensive acupuncture treatment was associated with further reduction in lumbar surgery rates. CONCLUSION The present results found that administration of acupuncture treatment is associated with lower lumbar surgery rates for LBP patients in Korea. Prospective studies are warranted in the future to further investigate the effect of acupuncture treatment on lumbar surgery incidence.
Collapse
Affiliation(s)
- Wonil Koh
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Kyungwon Kang
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Me-riong Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Joon-Shik Shin
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Jinho Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Jun-Hwan Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- University of Science & Technology (UST), Korean Medicine Life Science, Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Kyung-Min Shin
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| |
Collapse
|
22
|
Kapural L, Gilmore CA, Chae J, Rauck RL, Cohen SP, Saulino MF, Wongsarnpigoon A, McGee MJ, Boggs JW. Percutaneous Peripheral Nerve Stimulation for the Treatment of Chronic Low Back Pain: Two Clinical Case Reports of Sustained Pain Relief. Pain Pract 2017; 18:94-103. [PMID: 28296137 DOI: 10.1111/papr.12571] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/20/2017] [Accepted: 01/28/2017] [Indexed: 01/29/2023]
Abstract
As the leading cause of disability among U.S. adults, chronic low back pain (LBP) is one of the most prevalent and challenging musculoskeletal conditions. Neuromodulation provides an opportunity to reduce or eliminate the use of opioids to treat chronic LBP, but the cost and invasiveness of existing methods have limited its broad adoption, especially earlier in the treatment continuum. The present case report details the results of a novel method of short-term percutaneous peripheral nerve stimulation (PNS) in 2 subjects with chronic LBP. At the end of the 1-month therapy, stimulation was discontinued and the leads were withdrawn. PNS produced clinically significant improvements in pain (62% average reduction in Brief Pain Inventory Question #5, average pain), and functional outcomes (73% reduction in disability, Oswestry Disability Index; 83% reduction in pain interference, Brief Pain Inventory). Both subjects reduced nonopioid analgesic use by 83%, on average, and the one subject taking opioids ceased using all opioids. The only adverse event was minor skin irritation caused by a topical dressing. The clinically significant improvements were sustained at least 4 months after start of therapy (79% average reduction in pain; both reported minimal disability; 100% reduction in opioids; 74% reduction nonopioids). The results reveal the utility of this novel, short-term approach and its potential as a minimally invasive neuromodulation therapy for use earlier in the treatment continuum to produce sustained pain relief and reduce or eliminate the need for analgesic medications, including opioids, as well as more expensive and invasive surgical or therapeutic alternatives.
Collapse
Affiliation(s)
- Leonardo Kapural
- Center for Clinical Research and Carolina's Pain Institute, Winston Salem, North Carolina, U.S.A.,Department of Anesthesiology, Wake Forest University, Winston-Salem, North Carolina, U.S.A
| | - Christopher A Gilmore
- Center for Clinical Research and Carolina's Pain Institute, Winston Salem, North Carolina, U.S.A.,Department of Anesthesiology, Wake Forest University, Winston-Salem, North Carolina, U.S.A
| | - John Chae
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, U.S.A.,MetroHealth Rehabilitation Institute of Ohio, Cleveland, Ohio, U.S.A
| | - Richard L Rauck
- Center for Clinical Research and Carolina's Pain Institute, Winston Salem, North Carolina, U.S.A.,Department of Anesthesiology, Wake Forest University, Winston-Salem, North Carolina, U.S.A
| | - Steven P Cohen
- Pain Management Division, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A.,Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | | | | | | | - Joseph W Boggs
- SPR Therapeutics, LLC, Chapel Hill, North Carolina, U.S.A
| |
Collapse
|
23
|
Abstract
The Mexican artist Frida Kahlo (1907-1954) is one of the most celebrated artists of the 20th century. Although famous for her colorful self-portraits and associations with celebrities Diego Rivera and Leon Trotsky, less known is the fact that she had lifelong chronic pain. Frida Kahlo developed poliomyelitis at age 6 years, was in a horrific trolley car accident in her teens, and would eventually endure numerous failed spinal surgeries and, ultimately, limb amputation. She endured several physical, emotional, and psychological traumas in her lifetime, yet through her art, she was able to transcend a life of pain and disability. Of her work, her self-portraits are conspicuous in their capacity to convey her life experience, much of which was imbued with chronic pain. Signs and symptoms of chronic neuropathic pain and central sensitization of nociceptive pathways are evident when analyzing her paintings and medical history. This article uses a narrative approach to describe how events in the life of this artist contributed to her chronic pain. The purpose of this article is to discuss Frida Kahlo's medical history and her art from a modern pain sciences perspective, and perhaps to increase our understanding of the pain experience from the patient's perspective.
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Wenzel HHB, Veld RHI, Melman WPR, Havinga ME, Pakvis D. Psychological risk factors in back pain patients at an orthopaedic outpatient clinic. J Back Musculoskelet Rehabil 2016; 30:BMR716. [PMID: 27257982 DOI: 10.3233/bmr-160716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Psychological risk factors have shown to be important prognostic indicators of back surgery outcome. Prevalence of these risk factors has rarely been examined in an outpatient clinic population. Furthermore, it is unclear to which extent they play a role, in absence of routinely used psychological screening tools, in treatment assignment. OBJECTIVE First aim of this study was to examine the prevalence of psychological risk factors in back pain patients at an orthopaedic outpatient clinic. Second aim was to investigate the prognostic value of these identified risk factors in treatment assignment by the orthopaedic surgeons (conservative vs. surgery). METHODS Sixty-six adult back pain patients were included. Psychological risk factor prevalence was determined with the Hospital Anxiety and Depression Scale, Tampa Scale of Kinesiophobia and Pain Catastrophizing Scale. Prognostic value of these risk factors in treatment assignment was examined using statistics. RESULTS Respectively, 30 (45% HADS Anxiety), 27 (41%, HADS Depression), 19 (29%, PCS) and 37 (56%, TSK) patients scored above cut-off. No prognostic value of risk factors in treatment assignment, was found. CONCLUSIONS The majority of patients in our study is at risk of poor surgical outcome due to presence of psychological risk factors. Future studies should target the development of screening tools for an early identification of those at risk.
Collapse
|
26
|
Polly DW, Cher D. Ignoring the sacroiliac joint in chronic low back pain is costly. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:23-31. [PMID: 26855595 PMCID: PMC4725636 DOI: 10.2147/ceor.s97345] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Increasing evidence supports minimally invasive sacroiliac joint (SIJ) fusion as a safe and effective treatment for SIJ dysfunction. Failure to include the SIJ in the diagnostic evaluation of low back pain could result in unnecessary health care expenses. DESIGN Decision analytic cost model. METHODS A decision analytic model calculating 2-year direct health care costs in patients with chronic low back pain considering lumbar fusion surgery was used. RESULTS The strategy of including the SIJ in the preoperative diagnostic workup of chronic low back pain saves an expected US$3,100 per patient over 2 years. Cost savings were robust to reasonable ranges for costs and probabilities, such as the probability of diagnosis and the probability of successful surgical treatment. CONCLUSION Including the SIJ as part of the diagnostic strategy in preoperative patients with chronic low back pain is likely to be cost saving in the short term.
Collapse
Affiliation(s)
- David W Polly
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA; Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | | |
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Bujedo BM. Treatment of failed back surgery syndrome in a forty-three-year-old man with high-dose oxycodone/naloxone. Anesth Pain Med 2015; 5:e21009. [PMID: 25893186 PMCID: PMC4377163 DOI: 10.5812/aapm.21009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 08/13/2014] [Accepted: 09/20/2014] [Indexed: 12/26/2022] Open
Abstract
Introduction: Failed back surgery syndrome (FBSS) is an increasing cause of chronic pain in most countries. This poses high costs to both patients and National Health Organizations. Case Presentation: In this report, multimodal pain management based on daily high-dose oxycodone/naloxone (OXN 180/90 mg) led to reduced patient's pain score and improved quality of life. Conclusions: Oxycodone/naloxone can be a good alternative for the management of FBSS when other interventional or pharmacologic strategies have failed. In this case report, higher doses than those recommended as a maximum daily ceiling (80/40 mg) were safely used in one selected patient with noncancer severe pain.
Collapse
Affiliation(s)
- Borja Mugabure Bujedo
- Department of Anesthesiology, Critical Care and Pain Medicine, Donostia University Hospital, San Sebastian, Spain
- Pain Relief Unit, Chronic Pain Management, Donostia University Hospital, San Sebastian, Spain
- Corresponding author: Borja Mugabure Bujedo, Pain Relief Unit, Chronic Pain Management, Donostia University Hospital, San Sebastian 20014, Spain. Tel: +34-943007000, Fax: +34-943007233, E-mail:
| |
Collapse
|