MANAGEMENT OF FAILED BACK SURGERY SYNDROME AND RELATED DISORDERS

Fail Back Surgery Syndrome (FBSS) and post laminectomy syndrome are commonly associated with spinal adhesive arachnoditis and Complex Regional Pain Syndrome (CRPS). Post laminectomy and FBSS have common symptoms and their treatment by spinal cord surgery is typically unsuccessful, with subsequent development of lumbar and radicular pain, despite the use of modern physiatrics techniques and pharmacological approaches. Spinal arachnoiditis is an inflammatory process involving all three meningeal layers or the nerve roots and commonly produces persistent pain. Patients with inappropriately long post-surgery immobility periods are at risk of CRPS, which is characterized by functional limitations in walking, neuropathic pain, edema and colors changes in the affected limb. Among drugs for the treatment of neuropatic chronic pain established are Gabapentin, Tramadol, Venlafaxine or Duloxetine being most commonly applied as a multi-therapy approach. Physical therapy often helps with pain relief and gain of movement. Here we performed spinal cord stimulation (SCS) to treat FBSS. When well indicated, SCS can achieve up to 50% pain relief in VAS (visual analogic scale). Alternative treatment options include continuous intratechal morphine delivery and ozone therapy by spinal epidural endoscopy, which have been reported to reduce pain by more than 40%.