A new approach to the failed, failed back syndrome.

Area of Science:

• Neurosurgery
• Pain Management

Background:

• Failed back syndrome (FBS) presents as intractable pain, often attributed to nerve root damage.
• Existing treatments for FBS have limited efficacy, necessitating novel approaches.

Observation:

• A new screening test involving sequential spinal nerve blocks under fluoroscopic guidance was developed.
• This technique identifies specific nerve roots contributing to the patient's pain.

Findings:

• A microsurgical dorsal root rhizotomy, severing no more than two contiguous roots, was performed on patients with implicated nerves.
• The combined screening and operative technique demonstrated a 72% success rate in short-term follow-up (9-30 months) across 26 patients.

Implications:

• This minimally invasive approach offers a viable treatment option for patients with failed back syndrome, even with severe arachnoiditis.
• The findings suggest that targeting specific damaged nerve roots is crucial for effective pain relief in FBS.
• Further research should explore long-term outcomes and the applicability of this technique to a broader patient population.