The questions are objective and simple, with a score of "1" for each statement the patient agrees with, and "0" for each statement the patient does not agree with. The score is the sum of the values, with a minimum of "0" and a maximum of " The closer the score is to "24", the more severe the individual's disability with chronic low back pain is. This questionnaire has a cutoff score of "14", in other words, individuals with a score higher than 14 have disabilities.
The validity and reproducibility of the Portuguese version, translated and adapted, are well established in the literature. Rev Saude Publica.
Questionnaire, which comprises 26 questions covering a broad area and four specific domains physical, psychological, social relationships and environment. The quality of life scores of the WHOQOL-bref domains are from zero to ; the higher the value for each domain, the better the quality of life.
Emotional factors such as anxiety and depression were assessed by the Beck Scale. The BAI 20 Cunha JA. It consists of 21 symptoms listed, with four alternatives for each one, in ascending order of level of anxiety. The scale classifies anxiety as minimum points ; mild points ; moderate points ; and severe points. The BDI 21 The patient is asked to choose the answer that best fits their symptoms in the last week.
The sum of the scores identifies the level of depression. The following result is proposed for the degree of depression: minimum from points ; mild points ; moderate points ; and severe points. Excessive fear of movement and physical activity, which results in feelings of vulnerability to pain or fear of recurrence of the lesion, was observed by the Tampa Scale of Kinesiophobia TSK , 22 Acta Ortop.
The final score is a minimum of 17 and a maximum of 68 points. The higher the score, the greater the degree of kinesiophobia, indicating that the individual is afraid to move because of the low back pain.
As criteria for improvement and worsening, rates of score changes were calculated, for the questionnaires applied before and after the group intervention. We performed a descriptive analysis for all the study variables. To see which variables differed, the non-parametric Wilcoxon and Mann Whitney tests were applied. The significance level used for the tests was 0. More than half of the sample belonged to this socioeconomic level No patients were lost to follow-up.
Other data regarding the sociodemographic and clinical profile are shown in Table 2. Regarding pain and fear of movement, the table below Table 3 shows a comparison between the pre and post-intervention periods. The relationship between perceived quality of life in the pre- and post-intervention periods is shown in the figure below Figure 1.
The group initially had greater functional disabilities We observed statistically significant difference in post-intervention functional capacity 6.
The objective of this study was to evaluate the response of patients with failed back surgery syndrome to participating in an interdisciplinary program, in terms of pain, functional limitations, quality of life and emotional disturbances.
The instruments used in this study were important to verify the effectiveness of treatment and the patients' responses to it, as well as determining the individual needs, even though the service was performed in a group setting. Some patients can have surgery and feel good for 5 or 10 years — and then the next level up or down the spine can develop the same problem. That new problem can require undergoing a similar procedure, or starting over again with more conservative options — like physical therapy, medications, and injections — before considering surgery.
You have to figure out what the underlying cause is. Penn has access to all of the various tools we need to get a specific diagnosis. You can have special imaging studies; consultations with specialists who work with patients who have specific conditions, such as pseudoarthrosis; metabolism work-ups to assess calcium and vitamin D levels, thyroid function, and nutrition.
These are all a part of our multidisciplinary approach. We also have the ability from the anesthesiology standpoint to take care of anybody — no matter what kind of shape their lungs, heart, or kidneys are in. For the vertebrae to fully fuse, the spine must be stabilized and immobilized to a degree.
If the environment for growing new bone tissue is not quite right, the spinal fusion may prove ineffective. This is one of the main causes of failed back syndrome.
Another common scenario happens after a discectomy or laminectomy to relieve symptoms of a herniated disc when the patient has degenerative disc disease DDD.
The surgery may have been performed flawlessly, but DDD can affect multiple locations in the spinal column. Sometimes patients have one disc herniation repaired only to find that another herniation has occurred after recovery from the surgery, or a more minor existing herniation was being masked by stronger symptoms, which the surgery addressed.
The risk for failed back syndrome rises with each surgery. According to a review in Asian Spine Journal , about half of initial surgeries are successful.
That percentage, however, drops to 30 percent, then 15 percent, then 5 percent after the second, third and fourth surgeries. Aside from the choice of surgery, the number of surgeries and the presence of other spinal conditions, the risk of failed back syndrome can be increased by a number of factors after surgery. In the short-term, some of these include:. In later stages, changes to the spinal column can affect the way a patient moves, which can cause further spinal problems after time.
Gabapentin has been shown to be superior to naproxen in alleviating back and leg pain after spinal surgery [ 30 ]. Pregabalin plays a role in the prevention of pain before and after surgery, with its effect apparently increasing with time [ 31 ]. The use of opioids in chronic LBP has become increasingly controversial and is currently recommended for only short-term therapy. In fact, opioid treatment should be limited to a finite course over a few weeks given the absence of evidence to suggest any long-term pain improvement from its use [ 32 ].
Furthermore, mounting evidence has shown substantial morbidity risks associated with long-term opioid use, including addiction, dependence, overdose, and even death [ 25 , 32 ].
As part of the treatment regimen, some evidence suggests that cognitive behavioral therapy leads to a reduction in pain scores in the immediate postoperative period and during long-term disability [ 33 ]. Physical therapy may be used as part of a multimodal approach for pain management given its mild effectiveness in patients with chronic LBP.
However, no consensus exists on the best type of therapy [ 34 ]. Choosing the most appropriate management modality should be based on the type and pattern of pain syndrome experienced by the patient: those suffering from predominantly axial or mechanical pain and those with predominantly neuropathic lower limb pain.
As mentioned earlier, very few absolute indications exist for repeat spinal surgery. These include any disabling and progressive neurological deficit, be it association with bowel or bladder function impairment, cauda equina syndrome, or established spinal instability requiring reoperation [ 35 ].
Removal of pedicle screw instrumentation may be considered during predominantly axial or midline pain after lumbar fusion. In fact, a number of such cases showed a significant reduction in pain scores and opioid requirement after implant removal [ 36 ]. It is also important to consider the presence of significant adjacent segment disease or periprosthetic loosening, which may contribute to the pain, as well as underlying osteoporosis requiring appropriate medical management Fig.
Spinal cord stimulation SCS has been proven to be the most effective form of semi-invasive treatment in patients with predominantly neuropathic limb pain. North et al. A retrospective analysis of 16, patients with FBSS who underwent either reoperation or SCS implantation demonstrated that those with SCS implantation experienced less than half the complications compared with those who underwent reoperation after 90 days 6.
The role of SCS in patients with predominantly axial pain has previously been considered much less promising than that in patients with radicular pain. A recent multicenter randomized controlled trial conducted by Kapural et al. The trial showed that HF10 was superior to traditional SCS in the treatment of both axial and radicular pain, with HF10 having a better response rate The superior outcomes of HF10 therapy continued until 24 months in those with both back and leg pain [ 41 ].
The efficacy of the HF10 therapy has also been confirmed in an Australian cohort, with high trial success rates and significant pain reduction among patients who failed to respond to traditional SCS [ 42 ]. A number of other neuromodulation techniques have also been attempted, including burst, adaptive, dorsal root ganglion, and peripheral nerve field stimulation.
Based on one study conducted by Schu et al. A prospective study by Liem et al. Screening patients for SCS implantation requires comprehensive consultation wherein formal surgery is confirmed to have no further benefit and the patient receives optimal medical management, has realistic insight into their condition, and has no evidence of infection.
The surgical implantation of leads is associated with greater efficacy during the trial period. It is also worth considering that significantly higher rates of infection have been observed when using externalized leads during the trial.
Our approach to manage FBSS considers the limitations of surgical intervention on the spine, as well as the various patient-related factors that may lead to unsuccessful outcomes besides the presence of surgically ameliorable pathology.
The decision to perform surgery in patients with predominantly axial pain should be made with the understanding that many patients may not respond to the treatment. The importance of a competent multidisciplinary team in FBSS cannot be overstated.
Engagement between physicians, psychologists, physiotherapists, and other allied health professionals is essential in improving outcomes for patients with FBSS.
Conflict of Interest: No potential conflict of interest relevant to this article was reported. National Center for Biotechnology Information , U. Journal List Asian Spine J v. Asian Spine J. Published online Apr James R. Daniell 1, 2 and Orso L. Osti 1, 2. Find articles by James R. Orso L.
Find articles by Orso L. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Corresponding author: Orso L. E-mail: orsolosti gmail. This article has been cited by other articles in PMC. Abstract Postsurgical spine syndrome is becoming an increasingly common challenge for clinicians who deal with spinal disorders owing to the expanding indications for spinal surgery and the aging world population.
Keywords: Postsurgical spine syndrome, Failed back surgery syndrome, Repeat spinal surgery, Chronic pain management, Neuromodulation, Spinal cord stimulation. The Problem Repeat spinal surgery is a treatment option with diminishing returns.
0コメント