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1.
J Neurosurg Sci ; 68(1): 128-139, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36943763

RESUMO

INTRODUCTION: Spinal cord stimulation (SCS) is a modern neuromodulation technique extensively proven to be an effective modality for treatment of chronic neuropathic pain. It has been mainly studied for complex regional pain syndrome (CRPS) and failed back surgery syndrome (FBSS) and recent data almost uniformly establishes its statistically significant positive therapeutic results. It has also been compared with other available treatment modalities across various studies. However, long term data on maintenance of its efficacious potential remains less explored. Few studies have reported data on long follow-up times (>= 12 months) and have compared its efficacy with other treatment options for chronic pain, respectively. Our study pools and analyzes the available data and compares SCS with other treatment options. It also analyzes the efficacy of SCS in long term management of patients with chronic pain. EVIDENCE ACQUISITION: We reviewed all the data available on MEDLINE, Embase and Cochrane CENTRAL using a search strategy designed to fit our pre-set inclusion and exclusion criteria. Both single-arm and double-arm studies were included. The primary outcome was defined as decrease of visual analogue scale (VAS) by >50% at 6, 12 and/or 24 months after SCS. EVIDENCE SYNTHESIS: According to the pooled data of double-arm studies, SCS has unanimously proven its superiority over other treatment options at 6 months follow-up; however it fails to prove statistically significant difference in results at longer treatment intervals. Dorsal root ganglion stimulation, a relatively recent technique with the same underlying physiologic mechanisms as SCS, showed far more promising results than SCS. Single-arm studies show around 70% patients experiencing greater than 50% reduction in their VAS scores at 6 and 12 months. CONCLUSIONS: SCS is a viable option for management of chronic neuropathic pain secondary to FBSS and CRPS. However, data available for its long term efficacy remains scarce and show no further statistically significant results.


Assuntos
Dor Crônica , Síndromes da Dor Regional Complexa , Síndrome Pós-Laminectomia , Neuralgia , Estimulação da Medula Espinal , Humanos , Estimulação da Medula Espinal/métodos , Dor Crônica/terapia , Resultado do Tratamento , Neuralgia/terapia , Síndromes da Dor Regional Complexa/terapia , Síndrome Pós-Laminectomia/terapia , Medula Espinal
2.
J Neurol Surg A Cent Eur Neurosurg ; 85(2): 164-170, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36528020

RESUMO

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.


Assuntos
Síndrome Pós-Laminectomia , Córtex Motor , Humanos , Estimulação Magnética Transcraniana/métodos , Síndrome Pós-Laminectomia/terapia , Síndrome Pós-Laminectomia/etiologia , Manejo da Dor/métodos , Medição da Dor , Resultado do Tratamento
3.
Pain Pract ; 24(2): 261-269, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37753793

RESUMO

BACKGROUND: Failed back surgery syndrome (FBSS) is a constellation of conditions occurring after spine surgeries, characterized by the presence of persistent or recurring low back pain that has a significant impact on patients' quality of life. Neuromodulation in the form of Spinal Cord Stimulation (SCS) is considered an indispensable treatment modality in the management of certain chronic pain conditions and it is showing good results for improvement in pain scores and functional capacity of the FBSS patients. OBJECTIVES: To assess the change in pain scores, quality of life, and opioid medication intake as an outcome of neuromodulation procedures performed on patients diagnosed with failed back surgery syndrome, and to detect the post-procedure complications. METHODS: A prospective observational study was conducted at two university hospitals in Egypt and the U.S.A. during the period from September 2019 to August 2021 for patients who underwent spinal cord stimulation procedures for FBSS with follow-up period of at least 1 year. Patients who are 18 years old or older diagnosed with FBSS for more than 6 months and treated with spinal cord stimulation with successful trials during this time frame were included in the study. RESULTS: Thirty-four patients were included in this study who had successful SCS trials and underwent permanent implantation of SCS devices with post-procedure follow-up period of 12 months. Patients showed a median pain numerical rating scale (NRS) of 7/10 at baseline with a median NRS of 4/10 through the follow-up period. Basic mobility and daily activity scores assessed by activity measure of post-acute care (AM-PAC) showed significant improvement from the mean of 16.87 ± 2.74 at baseline to a mean of 19.97 ± 2.93 through follow-up. In addition, there was a reduction in opioid medication usage. Post-procedure complications was of low percentage with the most detected were battery dysfunction in 7 patients and pocket pain in 6 patients. Reoperation was needed in 13 patients with 4 needed just revision and 9 patients required a complete removal of the device. CONCLUSION: Spinal cord stimulation is an effective modality of treatment for cases of failed back surgery syndrome with a statistically significant reduction in pain scores and a significant improvement in quality of life. Also, it achieves a recognizable reduction in opioid analgesic medications, with a reliable safety profile as detected with the recorded post-procedure complications. However, randomized controlled trials with more patients and long-term follow-up are highly recommended.


Assuntos
Síndrome Pós-Laminectomia , Estimulação da Medula Espinal , Humanos , Adolescente , Adulto , Estimulação da Medula Espinal/métodos , Analgésicos Opioides/uso terapêutico , Síndrome Pós-Laminectomia/complicações , Qualidade de Vida , Analgésicos , Resultado do Tratamento , Medula Espinal
4.
Eur Rev Med Pharmacol Sci ; 27(23): 11303-11314, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38095379

RESUMO

OBJECTIVE: Chronic, refractory low back and lower extremity pain is a common problem. There are many causes for persistent low back pain, including spinal stenosis (SS), disc herniation, facet disease, sacroiliac disease, adjacent segment disease, ligamentous disease, and failed back surgery syndrome (FBSS). FBSS and SS are common and often result in chronic, persistent pain and disability. After the failure of conservative treatments, percutaneous epidural neuroplasty (PEN) is often used in managing low back pain. PATIENTS AND METHODS: We retrospectively analyzed 117 patients who received PEN for FBSS and SS between January 2018 and January 2019. Clinical outcomes were assessed with the visual analogue scale (VAS) score and the Oswestry disability index (ODI). The follow-up period was 6 months. We aimed to evaluate the effectiveness of percutaneous epidural neuroplasty in managing chronic refractory low back and lower extremity pain secondary to FBSS and SS and to compare the differences between outcomes of SS and FBSS groups, before and after PEN. RESULTS: Mean VAS scores were 6.15 ± 1.25 preoperatively, 2.97 ± 1.5 after 1 month, 3.18 ± 1.65 after 3 months, and 3.83 ± 1.64 after 6 months of follow-up. Mean ODI scores were 49.91 ± 13.87 preoperatively, 30.19 ± 12.01 after 1 month, 31.61 ± 12.46 after 3 months, 34.58 ± 12.52 after 6 months of follow-up. CONCLUSIONS: Percutaneous epidural neuroplasty was shown to be a safe and effective treatment in managing refractory back/leg pain following FBSS and SS.


Assuntos
Dor Crônica , Síndrome Pós-Laminectomia , Deslocamento do Disco Intervertebral , Dor Lombar , Humanos , Constrição Patológica/complicações , Dor Lombar/cirurgia , Dor Lombar/tratamento farmacológico , Síndrome Pós-Laminectomia/cirurgia , Síndrome Pós-Laminectomia/complicações , Estudos Retrospectivos , Deslocamento do Disco Intervertebral/cirurgia , Resultado do Tratamento , Dor Crônica/complicações , Vértebras Lombares/cirurgia
5.
Acta Neurochir Suppl ; 135: 179-195, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38153468

RESUMO

IntroductionSpinal Cord Stimulation (SCS) is an emerging minimally invasive technique which uses neuromodulation to manage different forms of intractable pain. SCS is a well-established option for the treatment of various pain conditions, and nowadays, indications are ever increasing.Materials and MethodsIn this study, we present our case series of 49 patients who underwent SCS at our Institution for the treatment of pain from different etiologies, and discuss our 10-year experience in SCS. For the purpose of this study, we also performed a systematic review of current indications and new perspectives in SCS.ResultsAmong our case series, patients were differentiated into two groups upon prior spinal surgery: patients who had undergone prior spinal surgery for back pain were defined as the "FBSS (failed back surgery syndrome) group," instead patient suffering from different types of pain but who had never undergone surgery were defined as the "naive group." As regards clinical response to SCS, 20 patients out of 36 (55.56%) were classified as responders in the FBSS group; in the "naïve" group, 10 patients out of 13 (76.92%) were classified as responders. Among the "not responders" group, several patients suffered from infections.Of the recent literature about SCS, 2124 records were screened and 37 studies were finally included in the qualitative synthesis for our systematic review.DiscussionIn case of FBSS, surgical revision is often associated with a high morbidity and corresponding low rates of success. Unfortunately, patients affected by chronic pain often become refractory to conservative treatments. Spinal Cord Stimulation (SCS) is nowadays considered as an effective therapy for several chronic and neuropathic pain conditions, such as failed back surgery syndrome. As regards the economic impact of SCS, implantation of an SCS system results in short-term costs increase, but the annual cumulative costs decrease during the following years after implantation, when compared to the costs of conventional management. Beyond the application for the treatment of FBSS, SCS has also been used for the treatment of other types of chronic non-oncological pain such as neuropathic pain and chronic back pain ineligible for surgical intervention. This evidence paved the way to establishing the potential role of SCS also for the treatment of oncological pain. However, the effectiveness and relative safety of SCS for cancer-related pain has not yet been adequately established.ConclusionsSpinal Cord Stimulation is a well-established treatment option in for FBSS. Beyond that, SCS has also been used for the treatment of "naive" patients, suffering from other types of chronic, both oncological and non-oncological, medical-refractory pain such as neuropathic pain and chronic back pain ineligible for surgical intervention.


Assuntos
Síndrome Pós-Laminectomia , Neuralgia , Estimulação da Medula Espinal , Humanos , Síndrome Pós-Laminectomia/terapia , Resultado do Tratamento , Neuralgia/terapia , Procedimentos Neurocirúrgicos
6.
Eur Spine J ; 32(10): 3370-3378, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37584698

RESUMO

PURPOSE: To outline clinical effectiveness of continuous epidural analgesia (CEA) in patients with failed back surgery syndrome (FBSS) or lumbar spinal stenosis (LSS) depending on severity of spinal degeneration. METHODS: In this retrospective cohort study, all patients with FBSS or LSS who underwent CEA within an inpatient rehabilitation program were evaluated. The pain reduction was measured by VAS on an hourly basis. Substantial pain reduction was defined as a minimal clinically important difference (MCID) > 50%. Severity of spinal degeneration, side effects and patient-specific characteristics were documented. RESULT: We included a total of 148 patients with 105 patients suffering from FBSS and 48 with LSS. The average pain reduction was - 37.6 ± 19.2 in FBSS and - 38.1 ± 17.8 in LSS group (p < .001 and p < .001, respectively). In the FBSS group, sensory deficits (p = .047) and numbness (p = .002), and in the LSS group, a severe disability measured by ODI (38.2 ± 15.4 vs. 57.3 ± 11.3, p < .001) significantly contributed to a worse outcome. The severity of the spinal degeneration and psychological disorders did not affect the pain reduction in terms of MCID. CONCLUSIONS: This study provides new evidence about CEA in the treatment of FBSS and LSS. CEA provides a significant pain reduction even under intensified physiotherapeutic exercising in patients with severe spinal degeneration and a broad variety of secondary diagnoses. Neurologic deficits in case of FBSS and severe disability in case of LSS may be risk factors for less favorable outcome.


Assuntos
Analgesia Epidural , Síndrome Pós-Laminectomia , Estenose Espinal , Humanos , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/cirurgia , Estenose Espinal/diagnóstico , Resultado do Tratamento , Vértebras Lombares/cirurgia
7.
Medicina (Kaunas) ; 59(7)2023 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-37512066

RESUMO

The introduction of the term Persistent Spinal Pain Syndrome (PSPS-T1/2), replacing the older term Failed Back Surgery Syndrome (FBSS), has significantly influenced our approach to diagnosing and treating post-surgical spinal pain. This comprehensive review discusses this change and its effects on patient care. Various diagnostic methods are employed to elucidate the underlying causes of back pain, and this information is critical in guiding treatment decisions. The management of PSPS-T1/2 involves both causative treatments, which directly address the root cause of pain, and symptomatic treatments, which focus on managing the symptoms of pain and improving overall function. The importance of a multidisciplinary and holistic approach is emphasized in the treatment of PSPS-T1/2. This approach is patient-centered and treatment plans are customized to individual patient needs and circumstances. The review concludes with a reflection on the impact of the new PSPS nomenclature on the perception and management of post-surgical spinal pain.


Assuntos
Síndrome Pós-Laminectomia , Estimulação da Medula Espinal , Cirurgiões , Humanos , Síndrome Pós-Laminectomia/terapia , Síndrome Pós-Laminectomia/diagnóstico , Manejo da Dor , Coluna Vertebral , Dor Pós-Operatória , Resultado do Tratamento
10.
Pain Res Manag ; 2023: 2136562, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37200968

RESUMO

Objectives: Failed back surgery syndrome (FBSS) refers to a condition where symptoms such as low back pain, leg pain, and numbness persist or recur after lumbar surgery; it has been reported to occur in 10%-40% of patients who have undergone lumbar surgery. Spinal cord stimulation (SCS) has been reported useful for low back and leg pain due to FBSS. In this study, we studied the efficacy and safety of SCS for FBSS in older adults. Methods: Among FBSS patients who underwent an SCS trial between November 2017 and December 2020, those with at least 50% pain reduction during the trial phase who requested spinal cord stimulator implantation underwent implantation of a stimulator under local anesthesia. The patients were divided into two groups: patients aged <75 years (<75-year-old group) and patients aged ≥75 years (≥75-year-old group). The male/female ratio, symptom duration, operative duration, visual analog scale (VAS) scores before and after one year of surgery, responder rate (RR), complications one year after surgery, and stimulator removal rate were analyzed. Results: There were 27 cases in the <75-year-old group and 46 in the ≥75-year-old group, with no significant differences in male/female ratio, duration of pain, or operative time between the two groups. VAS scores for low back pain, leg pain, and overall pain one year after surgery were improved significantly from respective preoperative scores in both groups (P < 0.001). There were no significant differences in low back pain VAS, leg pain VAS, overall pain VAS, RR, complications one year after surgery, or stimulator removal rate between the two groups. Conclusion: SCS reduced pain effectively in both <75-year-old and ≥75-year-old groups with no differences in complications. Therefore, spinal cord stimulator implantation was considered a viable option for FBSS treatment in older adults because it can be performed under local anesthesia and is associated with a low incidence of complications.


Assuntos
Síndrome Pós-Laminectomia , Dor Lombar , Estimulação da Medula Espinal , Idoso , Humanos , Masculino , Feminino , Estudos Retrospectivos , Síndrome Pós-Laminectomia/terapia , Síndrome Pós-Laminectomia/diagnóstico , Dor Lombar/cirurgia , Resultado do Tratamento , Medula Espinal
11.
Neuromodulation ; 26(5): 1009-1014, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37204362

RESUMO

BACKGROUND: Chronic pain has been associated with alterations in brain connectivity, both within networks (regional) and between networks (cross-network connectivity). Functional connectivity (FC) data on chronic back pain are limited and based on heterogeneous pain populations. Patients with postsurgical persistent spinal pain syndrome (PSPS) type 2 are good candidates for spinal cord stimulation (SCS) therapy. We hypothesize that 1) FC magnetic resonance imaging (fcMRI) scans can be safely obtained in patients with PSPS type 2 with implanted therapeutic SCS devices and that 2) their cross-network connectivity patterns are altered and involve emotion and reward/aversion functions. MATERIALS AND METHODS: Resting-state (RS) fcMRI (rsfcMRI) scans were obtained from nine patients with PSPS type 2 implanted with therapeutic SCS systems and 13 age-matched controls. Seven RS networks were analyzed, including the striatum. RESULTS: Cross-network FC sequences were safely obtained on a 3T MRI scanner in all nine patients with PSPS type 2 with implanted SCS systems. FC patterns involving emotion/reward brain circuitry were altered as compared with controls. Patients with a history of constant neuropathic pain, experiencing longer therapeutic effects of SCS, had fewer alterations in their connectivity patterns. CONCLUSIONS: To our knowledge, this is the first report of altered cross-network FC involving emotion/reward brain circuitry in a homogeneous population of patients with chronic pain with fully implanted SCS systems, on a 3T MRI scanner. All rsfcMRI studies were safe and well tolerated by all nine patients, with no detectable effects on the implanted devices.


Assuntos
Dor Crônica , Síndrome Pós-Laminectomia , Estimulação da Medula Espinal , Humanos , Estimulação da Medula Espinal/métodos , Dor Crônica/diagnóstico por imagem , Dor Crônica/etiologia , Dor Crônica/terapia , Estudos de Viabilidade , Síndrome Pós-Laminectomia/diagnóstico por imagem , Síndrome Pós-Laminectomia/terapia , Dor Pós-Operatória , Imageamento por Ressonância Magnética/métodos , Medula Espinal/diagnóstico por imagem
12.
Front Public Health ; 11: 1140506, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37081949

RESUMO

Introduction: Failed back surgery syndrome (FBSS) is defined as back pain which either persists after attempted surgical intervention or originates after a spine surgery. There is a high risk of perioperative morbidity and a high likelihood of extensive revision surgery in geriatric patients with FBSS or post-laminectomy foraminal stenosis. Methods: There is a need for less invasive methodologies for the treatment of FBSS, such as patient-tailored exercise training, with attention to the cost and special needs of the geriatric patients with FBSS. This commentary will provide some background regarding teleexercise (utilizing an internet-based platform for the provision of exercise-related care) for FBSS and will propose three exercises which are easy to administer over online-based platforms and can be the subject of future investigation. Results: Given the documented benefits of regular rehabilitative exercises for patients with FBSS, the high cost of face-to-face services, and the need for infection mitigation in the wake of the COVID-19 Pandemic, teleexercise may be a practical and cost-beneficial method of exercise delivery, especially for geriatric patients with limitations in mobility and access to care. It should be noted that, prescription of these exercises should be done after face-to-face evaluation by the physician and careful evaluation for any "red flag" symptoms. Conclusion: In this commentary, we will suggest three practical exercise training methodologies and discuss the benefits of teleexercise for geriatric patients with FBSS. Future research should aim to assess the efficacy of these exercises, especially when administered through telehealth platforms.


Assuntos
COVID-19 , Síndrome Pós-Laminectomia , Humanos , Idoso , Síndrome Pós-Laminectomia/diagnóstico , Síndrome Pós-Laminectomia/epidemiologia , Pandemias
15.
Spine (Phila Pa 1976) ; 48(11): E169-E176, 2023 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-36940259

RESUMO

STUDY DESIGN: Double-blinded, prospective laboratory animal study. OBJECTIVE: To examine whether intraoperative spinal cord stimulation (SCS) inhibits the development of spine surgery-induced hypersensitivity. SUMMARY OF BACKGROUND DATA: Managing postoperative pain after spine surgery is challenging, and as many as 40% of patients may develop failed back surgery syndrome. Although SCS has been shown to effectively reduce chronic pain symptoms, it is unknown whether intraoperative SCS can mitigate the development of central sensitization that causes postoperative pain hypersensitivity and potentially leads to failed back surgery syndrome after spine surgery. MATERIALS AND METHODS: Mice were randomly stratified into three experimental groups: (1) sham surgery, (2) laminectomy alone, and (3) laminectomy plus SCS. Secondary mechanical hypersensitivity was measured in hind paws using von Frey assay one day before and at predetermined times after surgery. In addition, we also performed a conflict avoidance test to capture the affective-motivational domain of pain at selected time points postlaminectomy. RESULTS: Mice that underwent unilateral T13 laminectomy developed mechanical hypersensitivity in both hind paws. Intraoperative SCS applied to the exposed side of the dorsal spinal cord significantly inhibited the development of hind paw mechanical hypersensitivity on the SCS-applied side. Sham surgery did not produce any obvious secondary mechanical hypersensitivity in the hind paws. CONCLUSIONS: These results demonstrate that spine surgery for unilateral laminectomy induces central sensitization that results in postoperative pain hypersensitivity. Intraoperative SCS after laminectomy may be able to mitigate the development of this hypersensitivity in appropriately selected cases.


Assuntos
Síndrome Pós-Laminectomia , Estimulação da Medula Espinal , Camundongos , Animais , Estimulação da Medula Espinal/métodos , Medição da Dor , Sensibilização do Sistema Nervoso Central , Síndrome Pós-Laminectomia/terapia , Estudos Prospectivos , Medula Espinal/cirurgia , Dor Pós-Operatória/prevenção & controle
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