Researchers from Boston University and the Dartmouth-Hitchcock Medical Center have examined one solution for those experiencing failed back surgery syndrome (FBBS). The study, “The Simplified Epiduralysis After Laminectomy/Fusion (SEAL) Procedure for Postsurgical Radicular Low Back Pain,” appears in the October 10, 2018 edition of Pain Medicine.
Solution for Failed Back Surgery Patients?
1 min read Premium comments
#backpainSecondary#spinefusion
Michael D. Perloff, M.D., Ph.D., with the Department of Neurology at the Boston University School of Medicine in Massachusetts tells OTW, “The epidural space can have subacute or chronic inflammation after lumbar spine surgery. Many times a patient would do well after surgery, if chronic inflammation would calm down.”
“Simplified epiduralysis after laminectomy/fusion (SEAL) is a modified epidural/epiduralysis procedure that puts medications and local volume pressure very proximal to the (previous) surgical location. Conventional epidural injections are not good at this. SEAL does not do as extensive epiduralysis as the Racz procedure or specialty catheters, but it does offer some epiduralysis to the perisurgical area and may benefit many patients with failed back surgery syndrome.”
According to the Boston University news release, simplified epiduralysis after laminectomy/fusion “… was performed on 30 patients who continued to experience low back and leg pain after back surgery. Short-to moderate-term pain relief was reported in 74% of these patients. Nearly 40% reported greater than 50% pain relief. After three years of follow-up, only one patient went on to repeat lumbar spine surgery.”
Dr. Perloff explained his experience with this novel procedure to OTW, “Some patients may just need one SEAL procedure, some may need repeat SEALs as therapy. Of course, it won’t help all failed back surgery syndrome patients, and in those cases, more complex (specialty catheter) epiduralysis may help, or spinal cord stimulators. The SEAL procedure offers a good initial procedural trial for failed back surgery syndrome that is low risk, low cost, and done in one short outpatient visit.”
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.