Dr Shantanu Mallick is the first Pain Physician in Navi Mumbai as well as in the whole Konkan belt of Maharashtra to get the FIPP Degree from World Institute of Pain, Texas, USA. It is one of the highest milestones in the field of pain management.
In the 1980s, the complex diagnosis of “failed back surgery syndrome (FBSS)” entered the medical literature. This unusual nomenclature refers to an unfortunate group of patients who, having undergone surgical treatment for a back problem, usually end up in worse condition than when they first sought medical care for the disorder.
After one or more laminectomies, spinal fusion, artificial disk implantation, bone growth electrical stimulation, and other operative procedures, these factors may include one or more of the following diagnoses:
Recurrent disk herniation
Nerve root compressed by scarring
Herniation of adjacent disk
Not uncommonly after one or two laminectomies, the spine becomes “destabilized” as portions of disks are removed and laminectomies are extended laterally, thus rendering the facet joints dysfunctional and painful. The sequence follows with a spinal fusion to stabilize that portion of the spine. Although spinal fusions are supposed to convert two or more vertebrae into one bony (with or without hardware) union, they may result in one or more of the following:
Protrusion of screws through the vertebral body
Protrusion of screws into the vertebral canal
Displacement of hardware (cages)
Malposition of screws
Fracture of screws
Impingement of nerve roots
A complete, detailed history, including diagnostic tests, adverse events, and attempted therapeutic modalities, described chronologically, is desirable. Specific tracking of the time of appearance of symptoms in relation to one of the operations performed not only may help to determine the cause of the FBSS but also may assist in considering certain therapeutic modalities that have not been of benefit in the past.
Repeated operations may produce both axial and radicular pain that may be caused by progression or overgrowth of a previous spinal fusion or hypertrophic osteophyte that may coexist with peridural scarring, thus significantly compressing the dural contents. Although bonyand ligamentum compression may be mechanically reduced, pain relief would likely be minimal.
Mechanical, noted as increased back pain when standing, walking, or sitting, including referred pain, muscle spasms, pain in the hips or sacroiliac joints, and bone friction, as in pseudarthrosis.
Neurologic, including headaches, electrical shock–like pain, burning, lacerating pain from stretching of the dural sac or the nerve roots, numbness, and weakness not following a dermatome path; symptoms indicate alterations of proprioception such as dizziness, tinnitus, a positive Romberg sign, and loss of balance
Functional, implying dysfunction of bladder, bowel, sexual activities, and autonomic dysfunction (e.g., excessive sweating, heat intolerance, hypertension)
Aggregated, caused by other related illnesses such as diabetic neuropathy, rheumatoid arthritis, and lupus erythematosus
Psychogenic, such as fears, depression, anxiety, hopelessness, insomnia, and suicidal ideation
Radicular, including pain and sensory alteration (e.g., numbness, tingling, formication) and weakness along a specific dermatome, usually resulting from extradural compression of a nerve root
Goals of Chronic Pain Management in Patients with FBSS
Improvement in physical activities and exercise tolerance
Reduction in narcotic use
Reduction in healthcare consumption
Return to work
GUIDE TO DIAGNOSIS AND THERAPY FOR FAILED BACK SURGERY SYNDROME
Retained disc fragment
Foreign body fragment
Nerve root cyst
H & P, MRI
H & P, MRI, electrodiagnostic
H & P, MRI
H & P, MRI, Myelogram
H & P, MRI, CT, X-ray
H & P, MRI
Bed rest, binder
Analgesics, muscle relaxants
Repeat CT / MRI
Protocol, Muscle relaxan
Surgical resection, Disc
Analgesics, oral steroids
H & P: HISTORY & PHYSICALS EXAMINATION
Epidural adhesiolysis is one of the most promising treatment in Epidural scarring.
Spinal Cord Stimulation is one of the most effective mode of treatment in specific cases.
Pain Care Clinic
Monday to Saturday
6.00 PM to 8.00 PM
Sadguru Pride, Shop no. 10, Sector-42A, Plot no 6, Beside Don Bosco School, Seawoods (w), Navi Mumbai.