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.
Related Topics
Privacy Policy, Terms and Conditions, DMCA Policy and Compliant
Copyright © 2018-2023 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.