Can Failed Back Surgery Syndrome Be Healed by Transverse Myelitis?
Failed back surgery syndrome (FBSS) is a condition characterized by persistent or recurring back pain following spinal surgery. Etiological factors for FBSS are being studied by investigators and clinicians in an attempt to organize them based on their temporal relation to the surgery event. However...
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Published in | Curēus (Palo Alto, CA) Vol. 15; no. 5; p. e39680 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
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United States
Cureus Inc
30.05.2023
Cureus |
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Abstract | Failed back surgery syndrome (FBSS) is a condition characterized by persistent or recurring back pain following spinal surgery. Etiological factors for FBSS are being studied by investigators and clinicians in an attempt to organize them based on their temporal relation to the surgery event. However, many questions regarding the pathophysiology of FBSS remain, which has resulted in a lack of efficacy among its treatment options. In this report, we present a remarkable case of longitudinally extensive transverse myelitis (LETM) in a patient with a medical history of FBSS who was taking multiple pain medications but had persisting pain. The patient, a 56-year-old woman, presented with an incomplete motor injury (American Spinal Injury Association Impairment Scale D) and a neurological level of C4. Investigations revealed an idiopathic LETM that was unresponsive to high doses of corticosteroids. An inpatient rehabilitation program was initiated, resulting in favorable clinical progress. The patient no longer complained of back pain, and her pain medication was gradually discontinued. At the time of discharge, the patient was able to walk with a stick, dress and groom herself independently, and eat with an adapted fork without experiencing pain. As the pain mechanisms underlying FBSS are complex and not yet fully understood, this clinical case aims to contribute to the discussion of possible pathological mechanisms implicated in LETM that may have contributed to the shutdown of pain perception in a patient with a history of FBSS. By doing so, we hope to identify new and effective ways to treat FBSS. |
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AbstractList | Failed back surgery syndrome (FBSS) is a condition characterized by persistent or recurring back pain following spinal surgery. Etiological factors for FBSS are being studied by investigators and clinicians in an attempt to organize them based on their temporal relation to the surgery event. However, many questions regarding the pathophysiology of FBSS remain, which has resulted in a lack of efficacy among its treatment options. In this report, we present a remarkable case of longitudinally extensive transverse myelitis (LETM) in a patient with a medical history of FBSS who was taking multiple pain medications but had persisting pain. The patient, a 56-year-old woman, presented with an incomplete motor injury (American Spinal Injury Association Impairment Scale D) and a neurological level of C4. Investigations revealed an idiopathic LETM that was unresponsive to high doses of corticosteroids. An inpatient rehabilitation program was initiated, resulting in favorable clinical progress. The patient no longer complained of back pain, and her pain medication was gradually discontinued. At the time of discharge, the patient was able to walk with a stick, dress and groom herself independently, and eat with an adapted fork without experiencing pain. As the pain mechanisms underlying FBSS are complex and not yet fully understood, this clinical case aims to contribute to the discussion of possible pathological mechanisms implicated in LETM that may have contributed to the shutdown of pain perception in a patient with a history of FBSS. By doing so, we hope to identify new and effective ways to treat FBSS. Failed back surgery syndrome (FBSS) is a condition characterized by persistent or recurring back pain following spinal surgery. Etiological factors for FBSS are being studied by investigators and clinicians in an attempt to organize them based on their temporal relation to the surgery event. However, many questions regarding the pathophysiology of FBSS remain, which has resulted in a lack of efficacy among its treatment options. In this report, we present a remarkable case of longitudinally extensive transverse myelitis (LETM) in a patient with a medical history of FBSS who was taking multiple pain medications but had persisting pain. The patient, a 56-year-old woman, presented with an incomplete motor injury (American Spinal Injury Association Impairment Scale D) and a neurological level of C4. Investigations revealed an idiopathic LETM that was unresponsive to high doses of corticosteroids. An inpatient rehabilitation program was initiated, resulting in favorable clinical progress. The patient no longer complained of back pain, and her pain medication was gradually discontinued. At the time of discharge, the patient was able to walk with a stick, dress and groom herself independently, and eat with an adapted fork without experiencing pain. As the pain mechanisms underlying FBSS are complex and not yet fully understood, this clinical case aims to contribute to the discussion of possible pathological mechanisms implicated in LETM that may have contributed to the shutdown of pain perception in a patient with a history of FBSS. By doing so, we hope to identify new and effective ways to treat FBSS. |
Author | Caldas, Jorge Evangelista, Rafaela Moreira, Elisa Soares, Tiago Torres, Ana |
AuthorAffiliation | 1 Physical Medicine and Rehabilitation, Tondela-Viseu Hospital Center, Viseu, PRT |
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Author_xml | – sequence: 1 givenname: Elisa surname: Moreira fullname: Moreira, Elisa organization: Physical Medicine and Rehabilitation, Tondela-Viseu Hospital Center, Viseu, PRT – sequence: 2 givenname: Tiago surname: Soares fullname: Soares, Tiago organization: Physical Medicine and Rehabilitation, Tondela-Viseu Hospital Center, Viseu, PRT – sequence: 3 givenname: Rafaela surname: Evangelista fullname: Evangelista, Rafaela organization: Physical Medicine and Rehabilitation, Tondela-Viseu Hospital Center, Viseu, PRT – sequence: 4 givenname: Ana surname: Torres fullname: Torres, Ana organization: Physical Medicine and Rehabilitation, Tondela-Viseu Hospital Center, Viseu, PRT – sequence: 5 givenname: Jorge surname: Caldas fullname: Caldas, Jorge organization: Physical Medicine and Rehabilitation, Tondela-Viseu Hospital Center, Viseu, PRT |
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Cites_doi | 10.1016/j.neuchi.2021.09.005 10.1177/21925682221141385 10.1212/wnl.59.4.499 10.1016/j.ncl.2012.09.008 10.1097/00002508-199506000-00024 10.1016/j.nrl.2015.06.013 10.1111/j.1526-4637.2011.01089.x 10.2147/JPR.S92776 10.1007/s11916-010-0111-0 |
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Copyright | Copyright © 2023, Moreira et al. Copyright © 2023, Moreira et al. This work is published under https://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. Copyright © 2023, Moreira et al. 2023 Moreira et al. |
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Keywords | chronic pain longitudinally extensive transverse myelitis (letm) spinal injury failed back surgery syndrome (fbss) chronic low back pain (clbp) |
Language | English |
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References | Purves D (ref11) 2001 Chan CW (ref2) 2011; 12 Alizadeh R (ref3) 2022; 68 (ref6) 2002; 59 Orhurhu VJ (ref4) 2023 Carnero Contentti E (ref5) 2017; 32 Baber Z (ref9) 2016; 9 Beh SC (ref12) 2013; 31 Al-Chalabi M (ref7) 2023 Harvey AM (ref1) 1995; 11 Papalia GF (ref8) 2023; 13 Thomas Cheng H (ref10) 2010; 14 |
References_xml | – volume: 68 year: 2022 ident: ref3 article-title: Pathogenesis, etiology and treatment of failed back surgery syndrome publication-title: Neurochirurgie doi: 10.1016/j.neuchi.2021.09.005 contributor: fullname: Alizadeh R – year: 2023 ident: ref4 article-title: Failed Back Surgery Syndrome contributor: fullname: Orhurhu VJ – year: 2023 ident: ref7 article-title: Neuroanatomy, Spinothalamic Tract contributor: fullname: Al-Chalabi M – volume: 13 year: 2023 ident: ref8 article-title: Non-invasive treatments for failed back surgery syndrome: a systematic review publication-title: Global Spine J doi: 10.1177/21925682221141385 contributor: fullname: Papalia GF – volume: 59 year: 2002 ident: ref6 article-title: Proposed diagnostic criteria and nosology of acute transverse myelitis publication-title: Neurology doi: 10.1212/wnl.59.4.499 – volume: 31 year: 2013 ident: ref12 article-title: Transverse myelitis publication-title: Neurol Clin doi: 10.1016/j.ncl.2012.09.008 contributor: fullname: Beh SC – volume: 11 year: 1995 ident: ref1 article-title: Classification of chronic pain - descriptions of chronic pain syndromes and definitions of pain terms publication-title: Clin J Pain doi: 10.1097/00002508-199506000-00024 contributor: fullname: Harvey AM – volume: 32 year: 2017 ident: ref5 article-title: Differential diagnosis and prognosis for longitudinally extensive myelitis in Buenos Aires, Argentina publication-title: Neurologia doi: 10.1016/j.nrl.2015.06.013 contributor: fullname: Carnero Contentti E – volume: 12 year: 2011 ident: ref2 article-title: Failed back surgery syndrome publication-title: Pain Med doi: 10.1111/j.1526-4637.2011.01089.x contributor: fullname: Chan CW – volume: 9 year: 2016 ident: ref9 article-title: Failed back surgery syndrome: current perspectives publication-title: J Pain Res doi: 10.2147/JPR.S92776 contributor: fullname: Baber Z – volume: 14 year: 2010 ident: ref10 article-title: Spinal cord mechanisms of chronic pain and clinical implications publication-title: Curr Pain Headache Rep doi: 10.1007/s11916-010-0111-0 contributor: fullname: Thomas Cheng H – year: 2001 ident: ref11 article-title: Central Pain Pathways: The Spinothalamic Tract contributor: fullname: Purves D |
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SubjectTerms | Back surgery Chronic pain Hospitals Inflammatory diseases Nervous system Neurology Pain Management Patients Physical Medicine & Rehabilitation Rehabilitation Spinal cord Spinal cord injuries |
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Title | Can Failed Back Surgery Syndrome Be Healed by Transverse Myelitis? |
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