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

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 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

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

Acupuncture Therapy ; Humans ; Low Back Pain ; surgery ; therapy ; Lumbosacral Region ; surgery ; Male ; Middle Aged ; Treatment Failure

Dynamic stabilization system plays an important role in the treatment of the degenerative lumbar spine. Fusion of short movement segments has little influences on the motion of lumbar spine. Meanwhile, preservation of movements of segment can prevent the degeneration of adjacent segment and maintain the possibility of disc replacement even under the condition that facet joints need to be excised. While maintaining the normal lumbar motion, dynamic stabilization system can not only decrease the load of intervertebral disc of corresponding movement segments and provide a good environment for the recovery of intervertebral disc and soft tissues, but also delay the degeneration of small facet and reconstruct the biomechanical function of spine.
Biomechanical Phenomena ; Humans ; Intervertebral Disc Displacement ; surgery ; Low Back Pain ; physiopathology ; surgery

OBJECTIVE: To compare the effectiveness of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope (OSE) and traditional posterior lumbar interbody fusion (PLIF) in the treatment of L_{4, 5} degenerative lumbar spondylolisthesis (DLS). METHODS: The clinical data of 58 patients with DLS who met the selection criteria admitted between February 2020 and March 2022 were retrospectively analyzed, of which 26 were treated with OSE-assisted posterolateral approach lumbar interbody fusion (OSE group) and 32 were treated with PLIF (PLIF group). There was no significant difference between the two groups in terms of gender, age, body mass index, Meyerding grade, lower limb symptom side, decompression side, stenosis type, and preoperative low back pain visual analogue scale (VAS) score, leg pain VAS score, Oswestry disability index (ODI), and the height of the anterior and posterior margins of the intervertebral space (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were compared between the two groups. The low back pain and leg pain VAS scores and ODI before operation, at 1 month, 6 months after operation, and last follow-up, the height of anterior and posterior margins of the intervertebral space before operation, at 6 months after operation, and last follow-up, the modified MacNab criteria at last follow-up after operation were used to evaluate the effectiveness; and the Bridwell method at last follow-up was used to evaluate the interbody fusion. RESULTS: Both groups successfully completed the operation. Compared with the PLIF group, the OSE group showed a decrease in intraoperative blood loss and postoperative hospital stay, but an increase in operation time, with significant differences (P<0.05). In the OSE group, no complication such as nerve root injury and thecal sac tear occurred; in the PLIF group, there were 1 case of thecal sac tear and 1 case of epidural hematoma, which were cured after conservative management. Both groups of patients were followed up 13-20 months with an average of 15.5 months. There was no complication such as loosening, sinking, or displacement of the fusion cage. The low back pain and leg pain VAS scores, ODI, and the height of anterior and posterior margins of the intervertebral space at each time point after operation in both groups were significantly improved when compared with those before operation (P<0.05). Except for the VAS score of lower back pain in the OSE group being significantly better than that in the PLIF group at 1 month after operation (P<0.05), there was no significant difference in all indicators between the two groups at all other time points (P>0.05). At last follow-up, both groups achieved bone fusion, and there was no significant difference in Bridwell interbody fusion and modified MacNab standard evaluation between the two groups (P>0.05). CONCLUSION OSE-assisted posterolateral approach lumbar interbody fusion for L_{4, 5} DLS, although the operation time is relatively long, but the postoperative hospitalization stay is short, the complications are few, the operation is safe and effective, and the early effectiveness is satisfactory.
Humans ; Spondylolisthesis/surgery* ; Low Back Pain/surgery* ; Retrospective Studies ; Lumbosacral Region ; Blood Loss, Surgical ; Endoscopes

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*