Failed Spine Surgery Research Articles

Preliminary Results of The Treatment for Failed Back Surgery Syndrome by Full Endoscopic Approach at Saint Paul General Hospital, in Hanoi, Vietnam

Objective: Patients with radiculopathy after failed spine surgery due to restenosis, regenerated bony spurs, or inadequate decompression face high risks for morbidity or disability following massive revision operations. Therefore, fully endoscopic spine surgery could be less invasive, safer, and more effective because of accurate exposure, precise decompression, and avoidance of neural tissue injury. Our report aimed to describe the clinical result of selected patients with failed back surgery syndrome (FBSS) treated with fully endoscopic spine surgery at Saint Paul General Hospital in Vietnam.Methods: We retrospectively reviewed 24 patients with FBSS who were treated with uniportal fully endoscopic surgery at Saint Paul General Hospital with an average follow-up period of 16 months.Results: The patients’ average age was 61 years (range, 24–83 years), and the difference between preoperative and postoperative leg pain at the last follow-up was statistically significant (preoperative leg pain visual analogue scale [VAS]=7.1; last follow-up leg pain VAS=0.8; p<0.01). The difference in Oswestry Disability Index scores between the preoperative assessment and the final examination was statistically significant (preoperative, 57.8; last follow-up, 21.2; p<0.01). According to improvements in the MacNab score, the percentage of patients who achieved good or excellent postoperative results was 75%.Conclusion: Major open surgery as a revisional procedure in patients with FBSS syndrome has many potential risks during and after surgery. Fully endoscopic spine surgery can be a safe and effective option for selected cases with lower risk.

A novel topical phytotherapy for normalization of aberrant leg-anatomical and biochemical risks in failed spine surgery associated with knee-osteoarthritis: A unique case study

Objective: The aim of the study was to normalize the aberrant leg-anatomical and biochemical parameters, to relieve pain syndromes and to improve quality of life without revision of failed spine surgery (FSS) and surgical intervention of coexisted knee-osteoarthritis (KOA) correlated with radiological images by specialized topical phytotherapy.
 Methods: A 45year-old gentleman was advice to undergo revision of FSS and surgical intervention for KOA. He refused to do the further surgeries and treated in OPTM Health Care during January-February 2018. Anatomical measurements included bilateral: the gap at the knee joint between the short head of the biceps femoris and the level of the bed in supine, diameters of muscles at the thigh, the calf, 4cm above and below the patella, angles of straight leg raising, knee flexion and extension in supine, and biomarkers (Interleukin-10, Tumour necrosis factor-alpha, C-reactive protein, Creatine kinase-muscle and Aldolase-A) were measured pre- and post-treatment using appropriate protocols. The patient was treated for 12-week with phytoextracts of established seven medicinal plants.
 Results: The percentages of improvements for all the above-mentioned abnormal leg-anatomical and biochemical parameters were observed at post-treatment: 63.81, 2.28, 0.81, 5.22, 0.82, 160.00,73.75 and 50.00 respectively for right leg and 69.60, 5.79, 2.79, 9.93, 0.82, 290.00, 85.33 and 54.55 for left leg in case of leg-anatomical features and 87.72, 66.39, 77.27, 22.77 and 48.41 respectively for biomarkers and that for international acclaimed pain parameters under VAS, WOMAC, ODI, LEFS, KPS and BMI were highlighted in the earlier study and the same under KOOS were recorded as pain(86.11), symptoms(89.29), ADL(79.42), Sport & Recreation(75.00) and QOL(68.75) with improved radiological images both lumbar and knee-joints as assessed by KL-grading scales(≥2).
 Conclusion: Results showed the deranged leg-anatomical and biochemical risks, together-with impaired international pain parameters during FSS associated with KOA can be normalized by specialized topical phytotherapeutic treatment within 12-week.

A novel approach for failed lumbar spine surgery with topical phytotherapeutic treatment: a unique case study

Objective: The aim of the study was to treat successfully the failed Lumbar Spinal Fusion Surgery (LSFS) with topical phytotherapy within twelve-week.
 Methods: A male patient, aged 45years, was cripple with acute pain due to slipped disc for 4years and subsequently undergone LSFS at L4-L5 3years back. Being failed in surgery, he was treated with topical application of phytoextracts of seven medicinal plants (Cissus quadrangularis, Calotropis gigantea, Zingiber officinalis, Rosemarinus officinalis, Boswellia serratia, Curcuma longa and Withania somnifera) mixed with sesame oil and beeswax with specialized technique for twelve-week.
 Results: The percentages of improvement in international-approved pain related abnormalities and overweight were observed after post-treatment: Visual Analogue Scale (VAS) (Right leg: 94.91, Left leg: 94.87 and Lower back: 93.62), WOMAC index (Pain: 88.23, Stiffness: 84.71 and Physical function: 74.07), Oswestry Disability index (ODI) (74.47), Lower Extremity Functional Scale (LEFS) (62.50), Karnofsky Performance Scale (KPS) (80.00) and Body Mass Index (BMI) (11.93) and substantial improvement in radiological images as assessed by KL grading scale (≥ 2).
 Conclusion: Results showed the failed LSFS at L4-L5 can be successfully treated with specialized topical phytotherapy within twelve-week, evidenced by normalization of international acclaimed pain parameters such as VAS, WOMAC index, ODI, LEFS, KPS and BMI and radiological feature as assessed by KL grading scale.
 Key word: Intervertebral disc degeneration; Failed spine surgery; Phytoextracts; Phytotherapy for failed LSFS; Medicinal plants

High hip center bipolar hemiarthroplasty for non-reconstructable pelvic discontinuity

A 79-year-old woman with bilateral lower extremity weakness due to cervical myelopathy presented at our department in 2002 after multiple reconstructive procedures in both hips for developmental dysplasia of the hip. In 1993, a bulk allograft in combination with an acetabular cage and a cemented cup were used to treat the left massive acetabular bone loss. The defect was type IVb by the classification of the American Academy of Orthopaedic Surgeons (D’Antonio et al. 1989) and Berry et al. (1999). In 2000, the acetabular construct failed mechani-cally while the existing cemented femoral stem remained well fixed (Figure 1A). Removal of the acetabular hardware was followed by implantation of a whole acetabular allograft. The allograft was stabilized with plates and screws, and a new cemented cup was inserted. 2 years later, allograft fracture and acetabular failure occurred again.In 2002, a high hip center bipolar hemiarthroplasty was per-formed via a standard posterior hip approach. Failed acetabu-lar component and hardware were removed but the femoral stem was left in situ as it was found to be stable. Capsular and periacetabular scar tissues were preserved as much as possible to create a soft tissue cavity to seat the bipolar head into. A 60-mm bipolar femoral head was inserted onto the femoral component to articulate with the periacetabular soft tissues in a high hip center mode. Its position was further augmented with capsular repair around the neck of the prosthesis (capsu-lar noose). A femoral condyle allograft was fixed to the ilium to serve as posterior superior acetabular wall. Postoperatively, the patient was advised to gradually increase her weight bearing using a walker or crutches. No casts or braces were applied. Within 6 months, the bipolar component migrated out of the acetabulum and articulated with the iliac soft tissues (Figure 1B). Although the patient had limb shortening, she had no pain and declined further surgery.The right hip required 7 reconstructive procedures, which led to pelvic discontinuity (type IVb) and resection arthroplasty in 1999 (Figure 1A). In 2000, a re-implantation was performed by using a reinforcement ring with a cemented polyethylene cup and a long cemented femoral prosthesis. 4 years later the was inserted onto the previously implanted and stable femo-ral stem and articulated with the soft tissues adjacent to the lateral ilium (Figure 1B). After surgery, the patient was able to transfer independently and ambulate short distances in her home with a walker.At 3 years postoperatively (right hip) and 5 years postop-eratively (left hip) the patient had no pain, relatively equal leg lengths, and could sit comfortably. Due to complete loss of lower extremity motor function associated with failed spine surgery and cervical myelopathy, the patient was non-ambu-latory. However, the Harris hip score (HHS) of the patient’s left hip had improved from 39 preoperatively to 58 postopera-tively. Similarly, the HHS of the patient’s right hip increased from 14 preoperatively to 58 postoperatively.

Failed Spine Surgery Syndrome in the Life and Career of John Fitzgerald Kennedy

1 Department of Orthopaedic Surgery, OP31 Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239. E-mail address: [email protected]

Schwerwiegende Risiken und Komplikationen der epiduralen Neurolyse nach Racz

Racz's minimal invasive epidural catheter procedure, also known as "epidural neuroplasty" is not only utilized in patients suffering from failed spine surgery ("failed back surgery syndrome") but also increasingly applied to non-surgical back pain patients to prevent chronification or deterioration. Its hypothesized principle of action is local epidural lysis of adhesions, neurolysis of vertebral nerve roots and local lavage of proinflammatory mediators by repeated injection of local anesthetics, corticosteroids, hyaluronidase and hypertonic saline solution. However adverse events are well known to occur in epidural neuroplasty. Complications of epidural neuroplasty are due to the procedure itself or due to specific drugs-related side effects. Unintended dural puncture, administration of the drugs to the subarachnoid or subdural space, catheter shearing, infection and severe hemodynamic instability during application are most commonly observed adverse events. Complications related to the procedure itself occur immediately, while complications relating to drug administration show later onset. Within this context, we report a case of severe meningitis with neurologic sequelae in a patient who received Racz catheter-treatment for unspecific low-back pain and provide an overview of the literature on other potential severe complications. As a consequence, we recommend that the Racz catheter procedure as yet should be restricted to controlled clinical trials with rigorous inclusion- and exclusion criteria.