학술논문
6. Persistent spinal pain syndrome type 2.
Document Type
Academic Journal
Author
van de Minkelis J; Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.; Anesthesiology and Pain Medicine, Elisabeth-Tweesteden Ziekenhuis, Tilburg, The Netherlands.; Peene L; Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Belgium.; Cohen SP; Anesthesiology, Neurology, Physical Medicine & Rehabilitation and Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Anesthesiology and Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.; Staats P; Anesthesiology and Pain Medicine, National Spine and Pain Centers, Shrewsbury, New Jersey, USA.; Al-Kaisy A; Pain Management Department, Gassiot House, Guy's and St. Thomas' NHS Foundation Trust, London, UK.; Van Boxem K; Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.; Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Belgium.; Kallewaard JW; Anesthesiology and Pain Medicine, Rijnstate Ziekenhuis, Velp, The Netherlands.; Anesthesiology and Pain Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.; Van Zundert J; Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.; Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Belgium.
Source
Publisher: Blackwell Science, Inc Country of Publication: United States NLM ID: 101130835 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1533-2500 (Electronic) Linking ISSN: 15307085 NLM ISO Abbreviation: Pain Pract Subsets: MEDLINE
Subject
Language
English
Abstract
Introduction: Persistent Spinal Pain Syndrome (PSPS) refers to chronic axial pain and/or extremity pain. Two subtypes have been defined: PSPS-type 1 is chronic pain without previous spinal surgery and PSPS-type 2 is chronic pain, persisting after spine surgery, and is formerly known as Failed Back Surgery Syndrome (FBSS) or post-laminectomy syndrome. The etiology of PSPS-type 2 can be gleaned using elements from the patient history, physical examination, and additional medical imaging. Origins of persistent pain following spinal surgery may be categorized into an inappropriate procedure (eg a lumbar fusion at an incorrect level or for sacroiliac joint [SIJ] pain); technical failure (eg operation at non-affected levels, retained disk fragment, pseudoarthrosis), biomechanical sequelae of surgery (eg adjacent segment disease or SIJ pain after a fusion to the sacrum, muscle wasting, spinal instability); and complications (eg battered root syndrome, excessive epidural fibrosis, and arachnoiditis), or undetermined.
Methods: The literature on the diagnosis and treatment of PSPS-type 2 was retrieved and summarized.
Results: There is low-quality evidence for the efficacy of conservative treatments including exercise, rehabilitation, manipulation, and behavioral therapy, and very limited evidence for the pharmacological treatment of PSPS-type 2. Interventional treatments such as pulsed radiofrequency (PRF) of the dorsal root ganglia, epidural adhesiolysis, and spinal endoscopy (epiduroscopy) might be beneficial in patients with PSPS-type 2. Spinal cord stimulation (SCS) has been shown to be an effective treatment for chronic, intractable neuropathic limb pain, and possibly well-selected candidates with axial pain.
Conclusions: The diagnosis of PSPS-type 2 is based on patient history, clinical examination, and medical imaging. Low-quality evidence exists for conservative interventions. Pulsed radiofrequency, adhesiolysis and SCS have a higher level of evidence with a high safety margin and should be considered as interventional treatment options when conservative treatment fails.
(© 2024 The Authors. Pain Practice published by Wiley Periodicals LLC on behalf of World Institute of Pain.)
Methods: The literature on the diagnosis and treatment of PSPS-type 2 was retrieved and summarized.
Results: There is low-quality evidence for the efficacy of conservative treatments including exercise, rehabilitation, manipulation, and behavioral therapy, and very limited evidence for the pharmacological treatment of PSPS-type 2. Interventional treatments such as pulsed radiofrequency (PRF) of the dorsal root ganglia, epidural adhesiolysis, and spinal endoscopy (epiduroscopy) might be beneficial in patients with PSPS-type 2. Spinal cord stimulation (SCS) has been shown to be an effective treatment for chronic, intractable neuropathic limb pain, and possibly well-selected candidates with axial pain.
Conclusions: The diagnosis of PSPS-type 2 is based on patient history, clinical examination, and medical imaging. Low-quality evidence exists for conservative interventions. Pulsed radiofrequency, adhesiolysis and SCS have a higher level of evidence with a high safety margin and should be considered as interventional treatment options when conservative treatment fails.
(© 2024 The Authors. Pain Practice published by Wiley Periodicals LLC on behalf of World Institute of Pain.)