Complex neuromodulation analgesic treatment for patient with failed back surgery syndrome: A case report
Abstract
Failed back surgery syndrome (FBSS) is one of causes chronic pain and disability. Treatment of FBSS is often complex and necessitates the use of a large number of analgesic methods.
Recently neuromodulation methods have become unsubstitutable in treatment of the most complicated FBSS patients. Neuromodulation analgesic systems have been officially established to chronic pain treatment possibilities in Czech Republic (CR) since May 2000.
According to many studies FBSS is the most frequent diagnosis for neuromodulation therapy. In this case report there is described very intricate state of chronic severy pain at patient with FBSS, who has been treated for long time with neurostimulation analgesic systems.
After upward revaluation finding there was approached to four surgeries in the lumbosacral spine. After them the patient suffered from severe residual pain exhibiting typical FBSS.
After exhausting all conservative methods we implemented repea - tedly analgesics via an epidural and intrathecal port systems with good results. But due to complications, especially infectious therapy had to be discontinued.
Therefore after introduction of neuromodulation treatment in CR we approached to the neuromodulation analgesic treatment at this patient with two epidural leads in January 2001. The patient used the neurostimulation system with good effects but complications prompted several revisions.
After complications with generator and mainly electrodes (migration and infection) we decided to introduce surgical lead and rechargeable system with good efficacy to date. This patient is an example of very complicated state of FBSS, where neuromodulation (neurostimulation) offered the last possibility of treatment.
Rechargeable device and surgical lead can be a good choice for patients with high energy needs and repeated percutaneous lead malfunction.