Abstract
Failed back surgery syndrome (FBSS) is characterized by the presence of persistent, disabling pain in the lower back and/or lower extremities following surgical intervention to the back. The etiology of FBSS is remains uncertain. However, the recent findings point out that the fibrosis and adhesion in the epidural space might be the contributor of the lower back pain and the radiculopathy of lower limbs. The purpose of this treatment is to provide an opening in the epidural space to facilitate further caudal epidural injections effective in outpatient clinics.
Three patients with FBSS who did not respond to conservative treatment underwent spinal epiduroscopic epiduroplasty (SEE). Three cases have had a surgical history of interbody fusion, interlaminal fenestration, and laminectomy, respectively. Caudal epidural injections, lumbosacral plexus blocks, psoas compartment blocks and other treatments failed to improve the pain scores and the scores of daily activities (RDQ, ODI and JOA scores). SEE was performed. Each patient showed excellent improvement in disability scores after SEE for 24 weeks. The intensity and the area of pain also decreased after SEE. All patients were satisfied with the procedure. For the treatment of remaining symptoms, patient continued to accept caudal epidural blocks in the outpatient clinics, surprisingly changed from “non-responders” to “responders”. From our experience of three cases, SEE is considered to be an alternative technique in treating pain in FBSS, not only to give immediate relief but to facilitate the further treatment in outpatient clinics.
