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首页> 外文期刊>Pain practice: the official journal of World Institute of Pain >Interventional pain management for failed back surgery syndrome
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Interventional pain management for failed back surgery syndrome

机译：介入疼痛管理失败手术综合症

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Patients who suffer from the condition known as failed back surgery syndrome (FBSS) present to the offices of physicians, surgeons, and pain specialists alike in overwhelming numbers. This condition has been defined as persistent back and/or leg pain despite having completed spinal surgery. As lumbar surgery continues to grow in prevalence, so will the number patients suffering from FBSS. It is important for physicians treating this population to expand their knowledge of FBSS etiologies and appropriate diagnostic imaging modalities, combined with confirmatory diagnostic injections, and proper technique for interventional pain procedures. In doing so, the physician may adequately be prepared to manage these complex cases in the future, ideally with the support of stronger evidence. Management begins with a systematic evaluation of common FBSS etiologies such as new-onset stenosis, recurrent herniated nucleus pulposus (HNP), epidural fibrosis, pseudarthrosis, and others. History and physical may be supplemented by imaging including X-ray, magnetic resonance imaging, or computed tomography myelography. Certain diagnoses may be confirmed with diagnostic procedures such as intra-articular injections, medial branch blocks, or transforaminal nerve root blocks. Once an etiology is determined, a multidisciplinary approach to treatment is most effective. This includes exercise or physical therapy, psychological counseling, medication, and interventional procedures. The most invasive treatment option, short of revision surgery, is spinal cord stimulation. This intervention has a number of studies demonstrating its efficacy and cost-effectiveness in this population. Finally, revision surgery may be used when indicated such as with progressive neurological impairment or with issues regarding previous surgical instrumentation.
机译：病人患此病症被称为背部手术失败综合征(的边后卫)礼物医生的办公室,医生和疼痛专家都压倒性的人数。条件定义为持久和/或腿部疼痛尽管完成脊髓手术。流行,所以将病人数量从的边后卫。治疗这个群体扩大的边后卫病因和适当的知识诊断成像模式,结合确认诊断注射,和适当的技术介入的痛苦过程。这样做,医生可能充分准备管理这些复杂的病例未来,理想与更强的支持证据。评估等共同的边后卫的病因最近诊断为狭窄、复发性椎间盘髓核髓版),硬膜外纤维化,假关节等。也许是对成像包括x射线,磁共振成像或计算断层扫描脊髓造影术。确认和诊断程序等关节内注射,内侧分支块,或transforaminal神经根块。确定病因,多学科治疗是最有效的方法。包括运动或物理治疗,心理咨询、药物和介入程序。修订手术的治疗选择,短脊髓刺激。许多研究证明其疗效在这个人口成本效益。修订手术时可能使用这样表示与进步的神经损伤或关于之前的手术问题仪表。

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