Today, low back pain constitutes one of the most difficult medical problems. Chronic back pain in some patients is refractory to medical, surgical, and behavioral therapy. Persistent or recurrent, chronic pain after spine surgery, referred to as failed back surgery syndrome, can present frustrating cases. When conservative treatments, such as physiotherapy, exercise programs, and epidural steroid injection can not alleviate pain, spinal cord stimulation offers a potentially beneficial treatment option. We describe our experiences on the effects of spinal cord stimulation in a patient with failed back surgery syndrome and a patient suffering from chronic intractable low back pain who obtained satisfactory pain relief and reduction of disability after the implantation of a spinal cord stimulator.
Back Pain ; Chronic Pain ; Failed Back Surgery Syndrome ; Humans ; Leg* ; Low Back Pain ; Spinal Cord Stimulation ; Spinal Cord* ; Spine

OBJECTIVE: At present, epidural steroid injection is one of the most frequently used method in the treatment for low back pain. But this method is nonspecific and results in a widespread of injected agent around the target point. So, we introduce combined nerve block and had good results. METHODS: The authors evaluated the effects of combined nerve block in 153 patients with low back pain, retrospectively. They had spinal stenosis, facet syndrome, herniated lumbar disc and failed back surgery syndrome. We operated combined nerve block to patients respectively, that is caudal block, facet block and iliolumbar & sacroiliac joint block. We used Depomedrol(R) 80mg in 2ml and 2% Emcaine(R) 400mg in 20ml as injection agents, Visual analog scale(VAS) for assessment of the effect was used. RESULTS: Six months after nerve block, the outcome of treatment for back pain was cured(a decrease in VAS score from 4 and over to 3 and under) in 35.3%, improved(a decrease in VAS score but 4 and over) in 32.7% and unchanged(no change in VAS score) in 32.0%. Overall rate of improvement was 68.0%. CONCLUSION: We think that combined nerve block is more specific and effective in patients with low back pain. Therefore, this technique could be alternative method to epidural steroid injection.
Back Pain ; Failed Back Surgery Syndrome ; Humans ; Low Back Pain* ; Nerve Block* ; Retrospective Studies ; Sacroiliac Joint ; Spinal Stenosis

OBJECTIVE: To evaluate the role of anterior lumbar interbody fusion in treatment of failed back surgery syndrome, the authors retrospectively analyzed the result of anterior lumbar interbody fusion performed in our institute. METHODS: Fifteen FBSS patients due to variable causes have been treated with anterior lumbar interbody fusion in our institute from April 1994 to June 1999. We analyzed clinical changes in 15 patients who were followed up for an average of 23 months. RESULTS: The etiologies of FBSS were post operative discitis(6 cases), post operative instability(3 cases), post operative adhesion(5 cases), and recurrence(1 case). These fifteen FBSS patients were treated with anterior lumbar interbody fusion. The overall treatment outcome was satisfactory(excellent and good) in 11 cases. Three patients were slightly improved, but post operative low back pain was remained. One patient who had underwent nerve root injury due to pedicle screw insertion showed no improvement. CONCLUSION: We conclude that the anterior lumbar interbody fusion for FBSS seems to be safe and favorable treatment in selective patients, because low incidence of nerve injury risk and post-operative infection.
Failed Back Surgery Syndrome* ; Humans ; Incidence ; Low Back Pain ; Retrospective Studies ; Treatment Outcome

Results from lumbar disc operation in general are favorable in 70% to 90% of patients. The rate of necessary reintervention of the primary discectomy, however, may be as high as one fifth of cases even though diagnostic and technical standards have been improved. The purpose of this study was to analyse the reasons for failure of primary discectomy and which factors might have influenced the outcome of revisions in 53 patients with failed back surgery syndrome from the years 1989 to 1993. Mean follow up duration was 11.4 months with range of 1 to 69 months. Before revisions, all patients had one or more lumbar disc operations in whom disabling pain, neurologic deficits, and/or lumbar instabilities have been persisted or newly developed. The most common intraoperative findings of patients with revision were recurrent or persistent disc material(35.9%) followed by incomplete decompression from previous operations(24.5%), and disc lesions at new level(11.3%). In overall, 77.3% of total patients showed satisfactor y results(fair, good, and excellent) but this figure drops to 39.6% when those with at least good or excellent outcomes are only considered as definitively improved. Moreover only 22.9% good results were obtained among 35 patients with those less than 6 months of symptom duration. As for the total number of operations undertaken, it can not be conclusively stated due to small numbers in each categories, but less favorable results have been observed in those with more than one revisions. The factors predicting good outcome from revisions in our series were:1) greater than 6 months of pain relief after primary operation, 2) sciatica more prominent than lower back pain, 3) fewer operations.
Decompression ; Diskectomy ; Failed Back Surgery Syndrome ; Follow-Up Studies ; Humans ; Low Back Pain ; Neurologic Manifestations ; Sciatica

OBJECTIVE: To evaluate the effect of hyaluronidase in patients with failed back surgery syndrome (FBSS) treated with interlaminar lumbar epidural injection (ILEI). METHOD: Sixty patients suffering from severe low back pain and sciatica were randomly allocated into three groups. Group T received ILEI with 2 ml triamcinolone 40 mg/ml and 5 ml bupivacaine 0.25%. Group H received ILEI with 1500 IU hyaluronidase and 5 ml bupivacaine 0.25%. Group TH received interlaminar lumbar epidural injection (ILEI) with 1500 IU hyaluronidase, 2 ml triamcinolone 40 mg/ml and 5 ml bupivacaine 0.25%. The effect was evaluated using Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) at pre-injection, 2 weeks, 6 weeks and 12 weeks after ILEI. RESULTS: After 2 weeks and after 6 weeks, patients in both Group T and Group TH had significant effectiveness more than Group H in decrease of VAS and ODI. After 12 weeks, only patients in Group TH had significant effectiveness in decrease of VAS and ODI (p<0.05). In every period, Group TH had the most effectivess in decrease of VAS and ODI after ILEI. CONCLUSION: ILEI for FBSS with triamcinolone and hyaluronidase is considered to have more long term effectiveness to reduce pain and improve function after ILEI than injection with triamcinolone alone or hyaluronidase alone.
Bupivacaine ; Failed Back Surgery Syndrome ; Humans ; Hyaluronoglucosaminidase ; Injections, Epidural ; Low Back Pain ; Sciatica ; Stress, Psychological ; Triamcinolone

BACKGROUND: The pathophysiologies of Failed Back Surgery Syndrome (FBSS) are epidural adhesion& fibrosis; arachnoiditis, neural encroachment, mechanical instability. Epidural adhesiolysis alleviate back pain through blocking the neural activity of scar area and decreasing the inflammation & edema. There are two methods of adhesiolysis, endoscopic & non-endoscopic adhesiolysis. Present study was aimed to compare the pain relief & side effects between two methods. METHODS: We investigated 86 post-laminectomy patients with low back pain and radiculopathy, who do not relieved with any kinds of conservative treatment. Nerve pathology was demonstrated and epidural fibrosis suspected or proved with MRI examination. Group I was consisted with non-endoscopic 41 patients, and Group II was endoscopic 45 patients. Evaluation included assessment of pain relief (visual analogue scale, VAS), rate of reprocedures and duration of pain relief (VAS < 5) at post-epidural adhesiolysis 2 week, and 1, 2, 6 months. We also looked for complication of adhesiolysis. RESULTS: Statistical analysis (t-test, chisquared test) demonstrated VAS & reprocedure rate was significantly low (P < 0.05) in group II at 6 month and duration of pain relief (VAS < 5) was more prolonged in group II. One patient in each groups complained skin eruption and pruritus, and one patient of group II was proved epidural abscess and one patient of group I complained headache. CONCLUSIONS: Endoscopic and non-endoscopic epidural adhesiolysis are effective and safe in patients, who was not relieved the symptoms with conservative treatment, but endoscopic epidural adhesiolysis is more recommendable because its more prolonged effect.
Arachnoid ; Arachnoiditis ; Back Pain ; Cicatrix ; Edema ; Epidural Abscess ; Failed Back Surgery Syndrome ; Fibrosis ; Headache ; Humans ; Inflammation ; Low Back Pain ; Magnetic Resonance Imaging ; Pathology ; Pruritus ; Radiculopathy ; Skin

Spinal cord stimulation (SCS) has been used since 1967 for refractory chronic pain. SCS has recently undergone a variety of technical modifications and advances, and it has been applied in a variety of pain conditions. SCS has been most commonly applied for those patients with chronic back and leg pain and failed back surgery syndrome (FBSS). The clinical hallmark of FBSS is chronic postoperative pain. The pain pattern varies and the pain may show an axial or radicular distribution. Chronic intractable pain after FBSS is difficult to treat. This report describes our experience with treating chronic pain in two patients who suffered from FBSS with a spinal cord stimulator. A permanent spinal cord stimulator was implanted after a successful trial of stimulation with temporarily implanted electrodes. After 5 months of follow-up, the two patients had satisfactory improvement of their pain.
Chronic Pain ; Electrodes, Implanted ; Failed Back Surgery Syndrome* ; Follow-Up Studies ; Humans ; Leg ; Low Back Pain ; Pain, Intractable ; Pain, Postoperative ; Spinal Cord Stimulation ; Spinal Cord*

Spinal cord stimulation (SCS) has been used since 1967 for refractory chronic pain. SCS has recently undergone a variety of technical modifications and advances, and it has been applied in a variety of pain conditions. SCS has been most commonly applied for those patients with chronic back and leg pain and failed back surgery syndrome (FBSS). The clinical hallmark of FBSS is chronic postoperative pain. The pain pattern varies and the pain may show an axial or radicular distribution. Chronic intractable pain after FBSS is difficult to treat. This report describes our experience with treating chronic pain in two patients who suffered from FBSS with a spinal cord stimulator. A permanent spinal cord stimulator was implanted after a successful trial of stimulation with temporarily implanted electrodes. After 5 months of follow-up, the two patients had satisfactory improvement of their pain.
Chronic Pain ; Electrodes, Implanted ; Failed Back Surgery Syndrome* ; Follow-Up Studies ; Humans ; Leg ; Low Back Pain ; Pain, Intractable ; Pain, Postoperative ; Spinal Cord Stimulation ; Spinal Cord*

BACKGROUND: Lumbar transforaminal epidural injections (LTEIs) have been utilized in the treatment of radicular pain, and LTEIs have the advantage of target-specificity. However, there have not been enough studies on the contrast patterns in LTEIs with using fluoroscopy. The purpose of this study was to evaluate the spreading epidural contrast patterns that are seen during real-time fluoroscopic guided LTEIs. METHODS: A total of 131 patients who underwent fluoroscopic guided LTEIs were studied. The inclusion criteria were those patients with low back pain and/or lower extremity pain that was caused by a herniated nucleus pulposus, lumbar spinal stenosis, failed back surgery syndrome, and herpes zoster-associated pain. We classified the contrast patterns in regard to the contrast flow spreading to the nerve root and/or the unilateral, bilateral or cylinderic type of epidural spreading on the AP view of the fluoroscopy and the ventral or dorsal epidural filling on the lateral view. In addition to the pattern analysis, we evaluated the range of contrast spreading from the cranial to the caudal epidural filling and the incidence of an intravascular flow pattern. RESULTS: Epidural spreading was seen in 126 cases (96.2%) of the total patients through the nerve root. Ventral spreading occurred in 120 cases (95.2%). On the AP view, a nerve root with unilateral, bilateral and cylinderic epidural filling was noted for 108 (85.7%), 9 (7.1%) and 9 (7.1%) cases, respectively. The contrast spreading to vertebral segments was smaller for the patients with lumbar spinal stenosis and failed back surgery syndrome than for the other groups (P < 0.0083). The incidence of intravascular injection was 11.1% (14/126). CONCLUSIONS: LTEIs using fluoroscopic visualization provided excellent assessment of the ventral epidural filling as well as nerve root filling. However, unilateral epidural spreading was prominent for the LTEIs.
Failed Back Surgery Syndrome ; Fluoroscopy ; Humans ; Imidazoles ; Incidence ; Injections, Epidural ; Low Back Pain ; Lower Extremity ; Nitro Compounds ; Spinal Stenosis

Epiduroscopy is very useful in the treatment of not only low back pain caused by failed back surgery syndrome, epidural scar or herniated disc but also by chronic refractory low back pain which does not respond to interventional conservative treatment including fluoroscopically-directed epidural steroid injections and percutaneous adhesiolysis. Because cauterization using a laser fiber has become recently available, a wider opening is required to enter into the sacral canal in the case of epiduroscopic laser neural decompression (ELND). However, in a few patients, it is difficult to insert a device into the epidural space due to stenosis around the opening, and there is no alternative method. Herein, we report a case where a hiatus rasp specially designed for such patients was used to perform the operation.
Cicatrix ; Constriction, Pathologic ; Decompression ; Epidural Space ; Failed Back Surgery Syndrome ; Humans ; Intervertebral Disc Displacement ; Low Back Pain