A new approach to the failed, failed back syndrome.
A new screening test and operative technique for the relief of intractable pain in the failed back syndrome has been devised and has yielded a 72% success rate on short-term follow-up (9--30 months) in 26 patients. This syndrome is thought to represent pain emanating from permanently damaged nerve roots and not from the arachnoiditis that was always present. Multiple spinal nerve blocks are carried out sequentially in the foramina under local anesthesia and fluoroscopic control, and if fewer than three nerves are implicated in the causation of the major portion of the patient's pain syndrome, a microsurgical dorsal root rhizotomy in which not more than two contiguous roots are severed is performed. This procedure can be adopted despite severe adhesive arachnoiditis.
D001100:Arachnoiditis / Q000150:complications; D001416:Back Pain / Q000209:etiology / Q000601:surgery*; D003560:Cysts / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009407:Nerve Block; D010148:Intractable Pain / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery; D013126:Spinal Nerve Roots / Q000601:surgery*