Treatment Options for Failed Back Surgery Syndrome: An Umbrella Systematic Review of Systematic Reviews on the Effectiveness of Therapeutic Interventions.

Background: Failed back surgery syndrome (FBSS) is a common and incapacitating condition affecting patients with previous spine surgery in whom treatment approach can be challenging. This study aimed to summarize existing secondary studies and up-to-date randomized clinical trials (RCTs) that assess the effectiveness of available treatment options for FBSS. Methods: Systematic searches were carried out in five databases (PubMed, Cochrane, Scielo, Epistemonikos, and Google scholar) for all systematic reviews on the effectiveness of treatment options for FBSS published after 2012. Outcomes of interest were pain levels measured through visual analog scale or numeric rating scale, Oswestry Disability Index, and quality of life. Methodological and risk of bias assessments were performed with the AMSTAR-2 tool for systematic reviews and the Joanna Briggs Institute checklist for RCT. Prospective PROSPERO registration: CRD42022307609. Results: Fifteen studies, seven systematic reviews, and eight RCTs met the inclusion criteria and fulfilled the methodological quality assessment. Of the 15 included studies, 8 were on neurostimulation, 4 on adhesiolysis, 4 on epidural or intrathecal injections, and 3 on other treatment modalities. The risk of bias was low in seven studies, moderate in five, and high in three. Conclusions: Based on this systematic overview and the considerable heterogeneity among studies, the FBSS therapeutic approach must be individualized. FBSS treatment should start with conservative management, considering the implementation of neurostimulation, a technique with the most robust evidence of effective results, in cases of refractory axial or neuropathic pain. As the last resource, in light of the evidence found, more invasive procedures or new surgical interventions are indicated.

Subacute Acromioclavicular Dislocation After Basal Coracoid Process Fracture: Indirect Reduction without Open Reduction and Internal Fixation: A Case Report.

CASE: A 55-year-old man presented with an isolated undisplaced basal coracoid process (CP) fracture after direct trauma over his right shoulder. One week later, he presented with pain and anatomical deformity over the acromioclavicular joint (ACJ). Shoulder x-rays and computerized tomography revealed a complete acromioclavicular (AC) dislocation and displaced CP fracture. Anatomical AC reduction and ipsilateral coracoid fracture reduction were obtained using fixation with a hook plate. At 12-month follow-up, the patient regained functionality and showed complete CP consolidation and anatomic alignment of the ACJ. CONCLUSION: Our alternative treatment of coracoid fracture associated with secondary subacute AC dislocation showed satisfactory functional results.

Reparación quirúrgica inmediata de la ruptura del tendón del pectoral mayor causada por levantamiento de pesas. Reporte de caso / Immediate surgical repair of pectoralis major tendon rupture caused by weightlifting. Case Report

La ruptura del tendón del músculo pectoral mayor es un evento raro para el cual está indicado la reparación quirúrgica en pacientes jóvenes y atléticos. La reparación puede hacerse de forma aguda o crónica, hasta o despúes de 8 semanas, respectivamente. Las reparaciones agudas han demostrado excelentes resultados, sin embargo, hasta el momento no se encuentran reportes de reparaciones quirúrgicas dentro de las primera 24 horas de la lesíon. Presentamos un caso de reparación quirúrgica inmediata de una ruptura del tendón del músculo pectoral mayor en un hombre de 45 años sin antecedentes de uso de esteroides, que ocurrió mientras levantaba pesas. El diagnóstico inmediato se confirmó con una RM de emergencia más la evaluación clínica. La intervención quirúrgica se realizó en menos de 24 horas. Se instauró un protocolo de rehabilitación gradual con ejercicios pasivos. Seis meses después de la cirugía, se encontró recuperación de la amplitud de movimiento y la fuerza del hombro, así como la restauración anatómica completa. Concluimos que la reparación quirúrgica precoz de una ruptura del tendón del músculo pectoral mayor, el primer día de la lesión, en menos de 24 horas, acompañada de una buena técnica quirúrgica y un protocolo de rehabilitación gradual, arrojó excelentes resultados seis meses después del trauma, similares a los reportados en la literatura para reparaciones agudas (<6 semanas). Nivel de evidencia: Nivel IV

The rupture of the pectoralis major muscle tendon in young and athletic patients is a rare event for which surgical repair is indicated. The repair can be acute or chronic, up to or after 8 weeks, respectively. Acute repair has shown excellent results, and so far there are no reports of surgical repairs within the first 24hours of the injury. A case is presented of the immediate surgical repair of a ruptured pectoralis major muscle tendon occurring in a 45-year-old man with no history of steroid use, while lifting weights. The immediate diagnosis was confirmed with an emergency MRI plus clinical evaluation. The surgical intervention was performed in less than 24hours. A protocol of gradual rehabilitation with passive exercises was established. Six months after surgery, there was recovery of range of motion and shoulder strength, as well as complete anatomical restoration. It is concluded that early surgical repair of a rupture of the pectoralis major muscle tendon on the first day of the injury, or in less than 24hours, accompanied by a good surgical technique and a gradual rehabilitation protocol, yielded excellent results six months after the trauma, similar to that reported in the literature for acute repairs. Evidence level: Level IV