Diagnosis and interventional treatment of pain syndromes after surgery for degenerative lumbar spine diseases

Volkov I.V.

Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg, Russia;
Nikiforov All-Russian Center of Emergency and Radiation Medicine, St. Petersburg, Russia

Karabaev I.Sh.

Nikiforov All-Russian Center of Emergency and Radiation Medicine, St. Petersburg, Russia

Ptashnikov D.A.

Vreden Russian Research Institute of Traumatology and Orthopedics, St.-Petersburg, Russia;
Mechnikov Northwest State Medical University, St.-Petersburg, Russia

Konovalov N.A.

OOO Klinika spinal'noĭ neĭrokhirurgii «Aksis»;
NII neĭrokhirurgii im. akad. N.N. Burdenko RAMN, Moskva

ORCID: 0000-0003-0824-1848

Khlebov V.V.

Nikiforov All-Russian Center of Emergency and Radiation Medicine, St. Petersburg, Russia

Diagnosis and interventional treatment of pain syndromes after surgery for degenerative lumbar spine diseases

Authors:

Volkov I.V., Karabaev I.Sh., Ptashnikov D.A., Konovalov N.A., Khlebov V.V.

More about the authors

Journal: Burdenko's Journal of Neurosurgery. 2018;82(5): 55‑61

DOI: 10.17116/neiro20188205155

Downloaded: 46

To cite this article:

Volkov IV, Karabaev ISh, Ptashnikov DA, Konovalov NA, Khlebov VV. Diagnosis and interventional treatment of pain syndromes after surgery for degenerative lumbar spine diseases. Burdenko's Journal of Neurosurgery. 2018;82(5):55‑61. (In Russ., In Engl.)
https://doi.org/10.17116/neiro20188205155

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Treatment of acute postoperative pain and prevention of chronic postoperative pain syndrome. Pirogov Russian Journal of Surgery. 2024;(12):81-86

Postoperative pain accompanies up to 20% of interventions for degenerative spine diseases (DSDs). The epidemiologic data are contradictory; clinical and radiological diagnostics is often low efficient; capabilities of interventional diagnosis and treatment techniques are poorly understood. Purpose — the study purpose was to investigate the structure of pain syndromes after surgery for DSDs of the lumbar spine, based on complex diagnostics, as well as to evaluate the capabilities of interventional treatment. Material and methods. We examined 310 patients with postoperative pain syndromes. Patients with obvious indications for repeated surgery were excluded from the analysis; the remaining patients underwent selective diagnostic blockades followed by interventional (puncture) treatment. A positive outcome was defined as a reduction in pain by 50% on the numerical rating scale (NRS-11), by 20% in the Oswestry index (ODI), and by 8 points in the sciatica bothersomeness index (SBI), with the effect lasting for 12 months. Predictive factors for the risk of pain syndromes were analyzed. Results. Out of 310 patients, 162 (52.6%) patients had no obvious indications for surgery. Radicular pain was detected in 56 (18.6%) of 310 patients; the positive treatment outcome was achieved in 38 (67.86%) of 56 patients. Facet pain was present in 29 (9.35%) patients; the positive treatment outcome was achieved in 23 (79.31%) patients. Discogenic pain was found in 12 (3.87%) patients; the positive treatment outcome was achieved in 5 (41.63%) patients. sacroiliac joint (SIJ) pain was present in 42 (13.55%) patients; the positive treatment outcome was achieved in 36 (85.71%) patients. Myofascial and competing pain was detected in 12 (3.87%) patients; the causes were not identified in 11 (3.55%) cases. The main risk factors were sagittal balance parameters. Conclusion. Complex diagnostics revealed postoperative pain not associated with surgical causes in 52.6% of cases; the origin of pain was identified in 49.95% of cases. Interventional treatment was effective in 64.81% of cases; failed back surgery syndrome was diagnosed in 16.13% of patients.

Keywords:

failed back surgery syndrome

postoperative pain syndrome

facet pain

degenerative spine disease

interventional pain management

diagnostic blockade

Authors:

Volkov I.V.

Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg, Russia;
Nikiforov All-Russian Center of Emergency and Radiation Medicine, St. Petersburg, Russia

Karabaev I.Sh.

Nikiforov All-Russian Center of Emergency and Radiation Medicine, St. Petersburg, Russia

Ptashnikov D.A.

Vreden Russian Research Institute of Traumatology and Orthopedics, St.-Petersburg, Russia;
Mechnikov Northwest State Medical University, St.-Petersburg, Russia

Konovalov N.A.

OOO Klinika spinal'noĭ neĭrokhirurgii «Aksis»;
NII neĭrokhirurgii im. akad. N.N. Burdenko RAMN, Moskva

ORCID: 0000-0003-0824-1848

Khlebov V.V.

Nikiforov All-Russian Center of Emergency and Radiation Medicine, St. Petersburg, Russia

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