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Chapter: Clinical Cases in Anesthesia : Low Back Pain

What is failed back syndrome (FBS) and how is it managed?

FBS is the failure to return to normal activities and/or lose pain complaints after lumbar surgery.

What is failed back syndrome (FBS) and how is it managed?

 

FBS is the failure to return to normal activities and/or lose pain complaints after lumbar surgery. The incidence is between 15% and 30%. The etiology of FBS includes complications (scarring) from the surgery or diagnostic procedures, incorrect diagnoses, inadequate surgery, and new pathology.

 

Treatment modalities focus on decreasing inflamma-tion around the nerve roots and/or decreasing scar tissue that may be causing irritation of the nerve roots. Pain management techniques that have been utilized for FBS include:

 

·  Selective nerve root blocks with local anesthetic and steroid.

 

·  Caudal/epidural steroid injections below or above the surgical scar.

 

·  Epidurolysis, which lyses adhesions in the epidural space. This can be accomplished either mechanically with a spring-tipped catheter or chemically with large volumes of steroids, hyaluronidase, local anesthetic, and possibly hypertonic saline, which have a local anesthetic as well as anti-inflammatory effect.

 

·  Epiduroscopy, which allows for lysis of adhesions and specific steroid injections under direct visualization.

 

·  Spinal cord stimulation has also been used for FBS with varying success. In properly chosen patients, one can expect that 50% of the patients will have a 50% decrease in pain after insertion of the stimulator.

 

·  Chronic analgesic regimens are frequently prescribed for patients with FBS in conjunction with the more definitive invasive techniques.

 

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Clinical Cases in Anesthesia : Low Back Pain : What is failed back syndrome (FBS) and how is it managed? |


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