The Experts below are selected from a list of 318 Experts worldwide ranked by ideXlab platform
Keith H. Langford - One of the best experts on this subject based on the ideXlab platform.
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Spinal cord stimulation for the Failed Back Syndrome
Spine, 1993Co-Authors: Mark S. Ledoux, Keith H. LangfordAbstract:Thirty-two patients with Failed Back Syndrome received a trial of spinal cord stimulation. Stimulators were internalized in 26; long-term follow-up was available for 23 of these patients. Seventy-six percent of the 22 patients with stimulators still present at 1 year and 74% of the 19 patients with stimulators still present at 2 years were receiving 50% or better pain relief. Patients routinely underwent pain team evaluation and therapy, psychological testing and a transcutaneous electrical nerve stimulator trial prior to consideration of spinal cord stimulation. The most common complication was electrode migration. Spinal cord stimulation should be considered as an important therapeutic modality in carefully selected patients with Failed Back Syndrome.
Harold A. Wilkinson - One of the best experts on this subject based on the ideXlab platform.
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Injection therapy for enthesopathies causing axial spine pain and the "Failed Back Syndrome": a single blinded, randomized and cross-over study.
Pain physician, 2005Co-Authors: Harold A. WilkinsonAbstract:BackGROUND Enthesopathies are a common cause of axial pain that is amenable to "minimally invasive" therapy. OBJECTIVE To evaluate the effectiveness of injection therapy for enthesopathies. DESIGN Single blinded, randomized, and cross-over study. METHODS Thirty-five patients diagnosed as having painful enthesopathies as a major pain generator were studied. Of the patients studied, 86% of patients had undergone prior lumbar spine surgery and all were referred for neurosurgical evaluation for possible surgery. Patients were injected either with anesthetics alone or with anesthetics combined with phenol-glycerol proliferant prolotherapy. Outcomes were analyzed both clinically at the time of regular follow-ups, and by a series of multipart questionnaires. RESULTS Patients received a total of 86 injections, 39 with local anesthetics, and 47 with prolotherapy. By clinical assessment patients obtained excellent to good relief of pain and tenderness after 80% of prolotherapy injections, but only 47% after anesthetics alone. By questionnaire, 66% reported excellent to good relief after prolotherapy vs. 34% after anesthetics alone. Patients reported improvement in work capacity and social functioning following both types of injections, but a greater reduction in focal pain intensity following prolotherapy injections. The mean and median durations of persistent relief were 2.4 and 1.75 months with prolotherapy vs. 1.8 and 0.75 months with anesthetics alone. Roughly 10% obtained greater than six months of relief from either injection. In the crossover portion of the study, patients reported that prolotherapy injections following initial anesthetic-only injections provided much better relief than that achieved after their anesthetic-only injections, and that anesthetic-only injections following initial prolotherapy injections Failed to provide relief as good as that achieved after their prolotherapy. Subsequent to this study, only four of 35 patients required additional spine surgery, but 29 of the 35 patients requested additional injections. CONCLUSIONS Injection therapy of painful enthesopathies can provide significant relief of axial pain and tenderness combined with functional improvement, even in "Failed Back Syndrome" patients. Phenol-glycerol prolotherapy provides better and longer lasting relief than injection with anesthetics alone. Prolotherapy provides over six months of relief for some patients but generally provides relief for only a few months. However, most patients described good to excellent relief, felt that the injections had been beneficial, and requested additional injections for recurrent or residual focal pain.
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The Failed Back Syndrome: Etiology and Therapy
1992Co-Authors: Harold A. WilkinsonAbstract:Introduction - aetiology, diagnosis and therapy the role of improper surgery in the aetiology of the Failed Back Syndrome symptomatic diagnosis precise diagnosis of specific Syndromes non-invasive therapy needle therapy surgical therapy medical and surgical therapies.
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The Role of Improper Surgery in the Etiology of the Failed Back Syndrome
The Failed Back Syndrome, 1992Co-Authors: Harold A. WilkinsonAbstract:In the United States, approximately two thirds of all patients enrolled in chronic pain centers suffer from the Failed Back Syndrome. Neurosurgeons perform 100,000 operations for lumbar disc disease every year, and orthopedic surgeons perhaps perform a similar number.6 It is estimated that between 20% and 40% of these operations are unsuccessful and result in the Failed Back Syndrome. Dr. William Sweet, former Professor and Chairman of Neurosurgery at the Massachusetts General Hospital, has estimated that, in contrast, only approximately 10% of patients enrolled in European pain clinics suffer from the Failed Back Syndrome.7 The reasons for this discrepancy are likely to be multiple, including, perhaps, Europeans’ greater stoicism and a less supportive acceptance of disability and non-productivity.
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Precise Diagnosis of Specific Syndromes
The Failed Back Syndrome, 1992Co-Authors: Harold A. WilkinsonAbstract:Patients with the Failed Back Syndrome should usually be treated initially with nonspecific and generally safer therapies. When simpler therapies fail, continued successful therapy must be based on a precise understanding of the disorder to permit an appropriate choice of specific therapy. As our knowledge of the complexity of the disorders that may cause the Failed Back Syndrome increases, it becomes more apparent that the “wastebasket diagnoses” of postoperative Back, chronic lumbar derangement, or even the all-encompassing term Failed Back Syndrome are not sufficiently precise to permit accurate therapy for many patients. Attempts at diagnosing precise causes of the Failed Back Syndrome should be undertaken in a systematic fashion. A carefully taken history is vitally important in all aspects of medicine, and this dictum holds true in understanding the causes of the Failed Back Syndrome.
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Team Approach or Individual Effort
The Failed Back Syndrome, 1992Co-Authors: Harold A. WilkinsonAbstract:Much of what is currently written about treatment of pain patients, including Failed Back Syndrome patients, assumes, recommends, or even proposes to mandate a team approach. In practice, how valuable is this approach? Are those who insist that it is the only valid approach correct in this assumption, or are they merely overly zealous?
Heikki Kröger - One of the best experts on this subject based on the ideXlab platform.
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Lumbar instrumented posterolateral fusion in spondylolisthetic and Failed Back patients: a long-term follow-up study spanning 11–13 years
European Spine Journal, 2012Co-Authors: Veli Turunen, Timo Nyyssönen, Hannu Miettinen, Olavi Airaksinen, Timo Aalto, Juhana Hakumäki, Heikki KrögerAbstract:Introduction and materials We examined lumbar transpedicular instrumented posterolateral fusion patients operated on between 1992 and 1997 presenting: degenerative spondylolisthesis with spinal stenosis; adult isthmic spondylolisthesis; Failed Back Syndrome after one to five discectomies; and Failed Back Syndrome after one to three laminectomy operations (Groups 1–4, respectively). Methods They were examined by an independent orthopedic surgeon, completed the Oswestry Disability Index (ODI) and visual analog scale (VAS) questionnaires and their outcome was evaluated. Results The overall patient satisfaction at follow-up (mean 11.7 years) was 82.1 %. The reoperation rate was 15.1 % (7.5 % due to adjacent segment disease). Conclusion Group 1 showed the greatest improvements in ODI and VAS values, Group 2 the lowest and Group 3 the highest preoperative values, and Group 4 the second highest improvements. Patient satisfaction scores were 90.3, 69.7, 63.6 and 80.0 %, respectively, and unplanned reoperation rates were 6.5, 9.1, 31.8 and 20.0 %. Thus, long-term outcomes of lumbar instrumented posterolateral fusion (rarely previously studied) were satisfactory for >80 % of patients, but varied among groups.
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Lumbar instrumented posterolateral fusion in spondylolisthetic and Failed Back patients: a long-term follow-up study spanning 11–13 years
European spine journal : official publication of the European Spine Society the European Spinal Deformity Society and the European Section of the Cerv, 2012Co-Authors: Veli Turunen, Timo Nyyssönen, Hannu Miettinen, Olavi Airaksinen, Timo Aalto, Juhana Hakumäki, Heikki KrögerAbstract:Introduction and materials We examined lumbar transpedicular instrumented posterolateral fusion patients operated on between 1992 and 1997 presenting: degenerative spondylolisthesis with spinal stenosis; adult isthmic spondylolisthesis; Failed Back Syndrome after one to five discectomies; and Failed Back Syndrome after one to three laminectomy operations (Groups 1–4, respectively).
Krishna Kumar - One of the best experts on this subject based on the ideXlab platform.
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Treatment of chronic pain by using intrathecal drug therapy compared with conventional pain therapies: a cost-effectiveness analysis
Journal of neurosurgery, 2002Co-Authors: Krishna Kumar, Gary R. Hunter, Denny D. DemeriaAbstract:Object. The object of this study was to compare the cost-effectiveness of intrathecal drug therapy (IDT) with that of conventional pain therapy (CPT) in patients suffering from chronic low Back pain caused by Failed Back Syndrome. In this study, the authors tabulated actual costs, in Canadian dollars, in a consecutive series of patients undergoing IDT within the Canadian health care system and have compared them with costs in a control group in the same environment. The influence of these treatments on the quality of life (QOL) was also analyzed. Methods. The authors report on a series of 67 patients suffering from Failed Back Syndrome, 23 of whom underwent implantation of a programmable drug delivery pump and 44 of whom acted as controls. Patients were followed for a 5-year period during which the investigators tabulated the actual costs incurred for diagnostic imaging, professional fees, implantation costs including hardware, nursing visits for maintenance of the pumps, alternative therapies, and hospitalization costs for breakthrough pain. From this data, cumulative costs for each group were calculated for a 5-year period. Patient responses on the Oswestry Pain Questionnaire were analyzed to assess the impact of treatment on QOL. The actual cumulative costs for IDT during a 5-year period were $29,410, as opposed to $38,000 for CPT. High initial costs of equipment required for IDT were recovered by 28 months. After this time point, managing patients with CPT became the more expensive treatment option for the remainder of the follow-up period. The Oswestry Disability Index showed a 27% improvement for patients in the IDT group, compared with a 12% improvement in the control group. Conclusions. In patients who respond to this treatment, IDT is cost effective in the long term despite high initial costs of implantable devices.
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Epidural spinal cord stimulation for treatment of chronic pain--some predictors of success. A 15-year experience
Surgical neurology, 1998Co-Authors: Krishna Kumar, Cory Toth, Rahulk Nath, Patricia LaingAbstract:BackGROUND We have used epidural spinal cord stimulation (SCS) for pain control for the past 15 years. An analysis of our series of 235 patients has clarified the value of specific prognostic parameters in the prediction of successful SCS. METHODS Patients were followed up for periods ranging from 6 months to 15 years with a mean follow-up of 66 months. The mean age of the 150 men and 85 women in the study was 51.4 years. Indications for SCS included Failed Back Syndrome (114 patients), peripheral vascular disease (39 patients), peripheral neuropathy (30 patients), multiple sclerosis (13 patients), reflex sympathetic dystrophy (13 patients), and other etiologies of chronic intractable pain (26 patients). RESULTS One hundred and eighty-nine patients received permanent devices; 111 (59%) of these patients continue to receive satisfactory pain relief. Pain attributable to Failed Back Syndrome, reflex sympathetic dystrophy, peripheral vascular disease of lower limbs, multiple sclerosis, and peripheral neuropathy responded favorably to spinal cord stimulation. In contrast, paraplegic pain, cauda equina Syndrome, stump pain, phantom limb pain, and primary bone and joint disease pain did not respond as well. Cases of cauda equina injury had promising initial pain relief, but gradually declined after a few years. After long-term follow-up, 47 of the 111 successfully implanted patients were gainfully employed, compared with 22 patients before implantation. The successful patients reported improvements in daily living as well as a decrease in analgesic usage. Multipolar stimulation systems were significantly more reliable (p < 0.001) than unipolar systems. Complications included hardware malfunction, electrode displacement, infection, and tolerance. CONCLUSION Aside from etiologies of pain Syndromes as a prognostic factor, we have identified other parameters of success. In patients who have undergone previous surgical procedures, the shorter the duration of time to implantation, the greater the rate of success (p < 0.001). The diagnosis of Failed Back Syndrome must be considered a confounding factor in our analysis. Those patients whose pain did not follow a surgical procedure had better responses to SCS than patients who had multiple surgical procedures prior to their first implant. The advent of multipolar systems has significantly improved clinical reliability over unipolar systems. Age, sex, and laterality of pain did not prove to be of significance.
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Deep Brain Stimulation for Intractable Pain: A 15-Year Experience
Neurosurgery, 1997Co-Authors: Krishna Kumar, Cory Toth, Rahulk NathAbstract:Objective During the past 15 years, we prospectively followed 68 patients with chronic pain Syndromes who underwent deep brain stimulation (DBS). The objective of our study was to analyze the long-term outcomes to clarify patient selection criteria for DBS. Methods Patients were referred from a multidisciplinary pain clinic after conservative treatment Failed. Electrodes for DBS were implanted within the periventricular gray matter, specific sensory thalamic nuclei, or the internal capsule. Each patient was followed on a 6-monthly follow-up basis and evaluated with a modified visual analog scale. Results Follow-up periods ranged from 6 months to 15 years, with an average follow-up period of 78 months. The mean age of the 54 men and 14 women in the study was 51.3 years. Indications for DBS included 43 patients with Failed Back Syndrome, 6 with peripheral neuropathy or radiculopathy, 5 with thalamic pain, 4 with trigeminal neuropathy, 3 with traumatic spinal cord lesions, 2 with causalgic pain, 1 with phantom limb pain, and 1 with carcinoma pain. After initial screening, 53 of 68 patients (77%) elected internalization of their devices; 42 of the 53 (79%) continue to receive adequate relief of pain. Therefore, effective pain control was achieved in 42 of 68 of our initially referred patients (62%). Patients with Failed Back Syndrome, trigeminal neuropathy, and peripheral neuropathy fared well with DBS, whereas those with thalamic pain, spinal cord injury, and postherpetic neuralgia did poorly. Conclusion DBS in selected patients provides long-term effective pain control with few side effects or complications.
Jürgen Krämer - One of the best experts on this subject based on the ideXlab platform.
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Results of lumbosacral distraction spondylodesis for the treatment of spondylolisthesis, Failed-Back Syndrome, and lumbar instability
European Spine Journal, 1992Co-Authors: J. Möller, R. H. Wittenberg, L. P. Nolte, R. Willburger, M. Jergas, Jürgen KrämerAbstract:Diverses méthodes de fusion lombo-sacrée sont utilisées dans le traitement des affections dégénératives rachidiennes. Les résultats sont très variables et dépendent de l'indicatio, du type de fusion, des implants et de la méthode d'évaluation. Par une analyse rétrospective clinique et radiologique après un délai postopératoire moyen de 3,9 mois, cette étude rend compte du résultat de la “spondylodèse lombo-sacrée en distraction” (LSDS) dans une série consécutive de 147 patients traités par arthrodèse pour spondylolisthésis, échec de la chirurgie lombaire ou instabilité lombaire. La LSDS consite en une greffe postéro-latérale associée à un greffon autologue cortico-spongieux en H enfoncé sous distraction entre les épineuses de L4 et de S1. Avec 81,0% de bons et excellents résultats, cette technique d'arthrodèse sans ostéosynthèse a montré ses meilleurs résultats dans le traitement des spondylolisthésis, tandis que dans les cas d'échec de la chirurgie lombaire ou d'instabilité lombaire il n'a donné que 62,3% des résultats excellents ou satisfaisants. Le taux de pseudarthroses était de 13,6% pour tout le groupe et l'on n'a pas trouvé de complications majeures comme une atteinte radiculaire, un déficit neurologique post-opératoire ou une sténose lombaire. Various methods of lumbosacral fusions for the treatment of degenerative spinal diseases are used clinically. Results vary greatly depending on indication, type of fusion, implants, and method of evaluation. In a retrospective clinical and radiological examination after an average follow-up time of 3.9 years this study reports on the outcome of lumbosacral distraction spondylodesis (LSDS) in a consecutive series of 147 patients being fused for the treatment of spondylolisthesis, Failed-Back Syndrome, or lumbar instability. LSDS consists of a posterolateral fusion together with an autologous corticocancellous H-graft wedged under distraction between the spinous processes of L4 and S1. With 81.0% good and excellent results this noninstrumented fusion technique showed the best outcome in patients with spondylolisthesis, while in cases with a Failed-Back Syndrome or lumbar instability only 62.3% excellent to satisfying outcomes were noted. The rate of pseudarthrosis was 13.6% in the whole patient group; no major complications such as nerve root damage, postoperative neurological deficits, or spinal stenosis were found.
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Results of lumbosacral distraction spondylodesis for the treatment of spondylolisthesis, Failed-Back Syndrome, and lumbar instability.
European spine journal : official publication of the European Spine Society the European Spinal Deformity Society and the European Section of the Cerv, 1992Co-Authors: J. Möller, R. H. Wittenberg, L. P. Nolte, Jergas M, R. Willburger, Jürgen KrämerAbstract:Various methods of lumbosacral fusions for the treatment of degenerative spinal diseases are used clinically. Results vary greatly depending on indication, type of fusion, implants, and method of evaluation. In a retrospective clinical and radiological examination after an average follow-up time of 3.9 years this study reports on the outcome of lumbosacral distraction spondylodesis (LSDS) in a consecutive series of 147 patients being fused for the treatment of spondylolisthesis, Failed-Back Syndrome, or lumbar instability. LSDS consists of a posterolateral fusion together with an autologous corticocancellous H-graft wedged under distraction between the spinous processes of L4 and S1. With 81.0% good and excellent results this noninstrumented fusion technique showed the best outcome in patients with spondylolisthesis, while in cases with a Failed-Back Syndrome or lumbar instability only 62.3% excellent to satisfying outcomes were noted. The rate of pseudarthrosis was 13.6% in the whole patient group; no major complications such as nerve root damage, postoperative neurological deficits, or spinal stenosis were found.
