Abstract
Background and Objectives: Clinicians are required to manage a growing number of elderly patients with several medical comorbidities, and invasive surgical treatments are sometimes not advisable for these patients. The aim of this study was to evaluate the efficacy of minimally invasive intraspinal canal treatment, trans-sacral canal plasty (TSCP), for patients with and without failed back surgery syndrome (FBSS). Materials and Methods: A multicenter analysis was conducted. TSCP was performed in patients with chronic low back pain and leg pain due to lumbar spinal disorders. An adhesiolysis by TSCP was carried out, then a mixture of steroid and local anesthesia was injected. Visual Analog Scales (VAS) for low back pain and leg pain, and complications were evaluated. Results: A total of 271 patients with a minimum 6-month follow-up were enrolled. There were 80 patients who had a history of previous lumbar spinal surgery (F group), and 191 patients without previous lumbar spinal surgery (N group). There were no significant differences in sex and age between the two groups. VAS scores for low back pain (N group/F group) preoperatively, immediately postoperatively, and 1 month, 3 months and 6 months postoperatively, were 51/52 mm, 24/26 mm, 33/34 mm, 30/36 mm, and 30/36 mm, respectively. VAS scores for leg pain were 69/67 mm, 28/27 mm, 39/41 mm, 36/43 mm, and 32/40 mm, respectively. Both VAS scores for low back pain and leg pain were significantly decreased from baseline to final follow-up in both groups (p < 0.01). However, VAS scores for leg pain at 3 months and 6 months postoperatively were significantly higher in F group (p < 0.05). There were three catheter breakages (2/3 in F group), and one dural tear in F group. Conclusions: TSCP significantly reduced both VAS scores for low back and leg pain in patients with and without FBSS. However, co-existence of intractable epidural adhesion might be associated with less improvement in FBSS.
Highlights
The aging of the population will be a worldwide problem
trans-sacral canal plasty (TSCP) was performed in the patients who suffered from chronic low back pain and leg pain due to lumbar spinal disorders
After local anesthesia was given around the sacral hiatus, the introducer was placed into sacral canal through the sacral hiatus under fluoroscopic guidance, the epidural access catheter was inserted through the introducer after the removal of the inner cylinder (Figure 1a)
Summary
The aging of the population will be a worldwide problem. According to the World Health Organization and the United Nations, when the proportion of persons aged 65 years or older exceeds 7% in a society, it is called an aging society. Because clinicians are required to manage an increasing number of elderly patients, and associations between increasing age, increasing operative duration, length of stay, and revision surgery with adverse events have been reported [2], surgical invasiveness should be reduced to avoid perioperative complications, especially in elderly and immunocompromised patients. PEN would be a less invasive approach for FBSS in the elderly or immunocompromised patients. The aim of this study was to evaluate the efficacy of minimally invasive intraspinal canal treatment, trans-sacral canal plasty (TSCP), for patients with and without failed back surgery syndrome (FBSS). TSCP was performed in patients with chronic low back pain and leg pain due to lumbar spinal disorders. Conclusions: TSCP significantly reduced both VAS scores for low back and leg pain in patients with and without FBSS. Co-existence of intractable epidural adhesion might be associated with less improvement in FBSS
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