Therapeutic Interventional Procedures following Failed Back Surgery; Is It Worth it?

Abstract

Background Data: Treatment of failed back surgery syndrome (FBSS) is challenging to any spine surgeon or pain specialist. Purpose: The study aims to evaluate pain and functional outcome in response to lumbar spine interventional procedures in failed back. Study Design: Prospective non-randomized clinical case study. Patients and methods: Between Jan 2013 to Jan 2016, 35 patients with FBSS were included. Every patient was subjected to history taking, physical examination, and diagnostic imaging. Patients received a fluoroscopy guided lumbar spine procedures according to the failed back cause. A visual analog scale (VAS) for pain intensity, and Oswestry Disability index (ODI) were completed before the intervention maneuverand continued for one year during follow up. Patients were prepared for another intervention or surgery if he didn’t respond to the maneuver according to the case. Results: Patients were predominately females (62.9%) with a mean age of 39.74±12.37 years. Clinical and radiological finding revealed; 31.4% canal or foraminal stenosis, 25.8% facet arthropathy, 17.2% epidural scar, 14.3% recurrent disc, and 11.3% degenerative sacroilitis. After intervention procedure, and during 12 months follow up, one way ANOVA test was significant with P=0.001 for both VAS and ODI. Multivariate logistic regression analysis for both VAS and ODI after one year revealed that proper diagnosis and intervention maneuver were the independent factors that affect both with P value (0.001, 0.002), and (0.001, 0.018) respectively. Only 22.9% of cases end up with surgery during this year. Conclusion: Intervention procedures in FBSS can improve pain scale and functional outcome in most cases up to one year. Surgery should be the last line of therapy when the case is indicated. (2016ESJ117)

Keywords

• Failed back surgery syndrome
• therapeutic interventional
• lumbar spine