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6. Persistent spinal pain syndrome type 2 – Lumbar Fusion

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The article discusses Persistent Spinal Pain Syndrome (PSPS), which includes chronic axial and extremity pain. Two subtypes are identified: PSPS-type 1 without previous spinal surgery and PSPS-type 2 persisting after spine surgery, formerly known as Failed Back Surgery Syndrome. The etiology of PSPS-type 2 can be determined through patient history, physical examination, and medical imaging. Conservative treatments like exercise and behavioral therapy show low-quality evidence, while interventional treatments like pulsed radiofrequency and spinal cord stimulation are more effective. The diagnosis of PSPS-type 2 is based on comprehensive assessment, and interventional options should be considered when conservative treatments fail

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most experienced spinal facility in UK

Published article

S: 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.

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Pain Pract. 2024 Apr 14. doi: 10.1111/papr.13379. Online ahead of print. 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,

Pain Pract. 2024 Apr 14. doi: 10.1111/papr.13379. Online ahead of print.

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.

S: 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.

PMID:38616347 | DOI:10.1111/papr.13379

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6. Persistent spinal pain syndrome type 2

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Pain Pract. 2024 Apr 14. doi: 10.1111/papr.13379. Online ahead of print. 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

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