Demographic characteristics and medical service use of failed back surgery syndrome patients at an integrated treatment hospital focusing on complementary and alternative medicine: a retrospective review of electronic medical records.

Hee Seung Choi,Joon-Shik Shin,Jaehoon Jung,In-Hyuk Ha,Me-Riong Kim,Jinho Lee,Eun Hya Chi

doi:10.1155/2014/714389

Abstract

Objective. To report the patient demographics and nonsurgical complementary and alternative medicine treatment used at a Korean medicine hospital for low back pain (LBP) and/or sciatica after surgery. Methods. Medical records of patients who visited a spine-specialized Korean medicine hospital at 2 separate sites for continuous or recurrent LBP or sciatica following back surgery were reviewed. The demographics, MRI and/or CT scans, and treatments were assessed. Results. Of the total 707 patients, 62% were male and the average age was 50.20 years. Ninety percent of patients presented with LBP and 67% with sciatica. Eighty-four percent were diagnosed with herniated nucleus pulposus at time of surgery. Of these patients, 70% had pain recurrence 6 months or later, but 19% experienced no relief or immediate aggravation of pain after surgery. Many patients selected traditional Korean medicine treatment as primary means of postsurgery care (47%). When time to pain recurrence was short or pain persisted after surgery, return of symptoms at the same disc level and side was frequent. Conclusion. An integrative treatment model focusing on Korean medicine and used in conjunction with radiological diagnostics and conventional medicine is currently used as a treatment option for patients with pain after lumbar spine surgery.

Highlights

Low back pain (LBP) is considered to have a favorable natural prognosis, lumbar spine surgery is still frequently performed
This retrospective multicenter study assesses the demographics of the patients who visited Jaseng Hospital of Korean Medicine in Seoul, Korea, and Bucheon Jaseng Hospital of Korean Medicine in Bucheon, Korea, from January to December, 2012, for low back pain or sciatica recurrence after surgery and the treatment received through electronic medical records
Demographic characteristics included patients’ sex, age, occupation, and medical history including hyper-tension/ diabetes, site of pain, number of operations, recommendations for repeat surgery, duration of time from surgery to pain recurrence, duration of pain, limited lumbar range of motion (ROM) due to pain, pain intensity (NRS, Numeric Rating Scale), treatments received prior to current hospital visit, primary diagnosis for surgery as reported through patient recollection, mode of onset of pain recurrence, number of MRI/CT scans performed after surgery at study setting, number of MRI/CT scans performed at other clinics or hospitals, number of patients who received inpatient treatment, and average length of hospital stay

Summary

Introduction

Low back pain (LBP) is considered to have a favorable natural prognosis, lumbar spine surgery is still frequently performed. In the US, the prevalence of lumbar fusion surgery has increased 220% from 1990 to 2001 [1], and 250,000 laminectomies are estimated to be conducted each year as of 2002 [2]. A 10- to 22-year follow-up study by Yorimitsu et al on the outcomes of discectomy for lumbar herniated nucleus pulposus (HNP) reported 74.6% of patients had residual LBP and 12% required reoperation(s) [3]. In Korea, a retrospective cohort study using national health insurance data of 35,558 patients who received a first surgery for lumbar herniated intervertebral disc disease in 2003 reported that the cumulative reoperation rate at 5 years was 13.4% with half the reoperations performed in the first postoperative year [4]. Park and Kim reported the results of 186 patients seeking medical care due to persistent or aggravated pain after surgery, of whom 75% visited within 2 years of surgery and 35% required reoperations [5]

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Conclusion