Failed back surgery syndrome Or Post Laminectomy Syndrome
In back surgery, doctors work with the aim of reducing a patient’s pain by changing the spine's anatomy, especially at the lesion site. Because of this, there is no definitive guarantee that back surgery will remove back pain.
The term post laminectomy syndrome is used to describe persistent pain after spine surgery. Failed Back Surgery Syndrome or Failed Back Syndrome is older names for this condition. The diagnosis of post laminectomy syndrome is given when there is persistent or recurrent neck or neck and arm pain following neck surgery, or back or back and leg pain following low back surgery.
 
Post laminectomy syndrome is most common after fusion or laminectomy but can occur following discectomy as well. The incidence of FBSS ranges between 5 and 50%, according to a study done in 2005 in Prague, Czech Republic. The author of the study attributes the high percentage of FBSS cases in part to the rise in number of surgeries performed.

Failed back surgery syndrome can be due to a number of factors that doctors and researchers are still discussing. These include:

  • Scar tissue that forms around the surgery site, interrupting normal neurological functioning.

  • The technicalities of the operation are not successful, the performing surgeon had poor technique, and/or there is iatrogenic injury present.

  • The surgery is not performed at the site that causes the pain.

  • The surgery performed is not actually necessary.

  • The patient is a poor fit for a successful surgery.

  • The diagnosis was incorrect.

  • Complications of surgery arise.
 

There are many possible causes for the condition including recurrent disc herniation, epidural fibrosis (scarring), arachnoiditis, spinal stenosis, sacro-iliac joint dysfunction, persistent pathological changes in nerve tissue resulting in chronic neuropathic pain, structural changes in the spinal column, and progression of  degenerative processes. 

Most patients with FBSS have accompanying psychological, social and/or vocational problems indirectly related to the pain. It’s important that these issues be carefully sorted out before any decision to go back for more surgery is made, as they can cloud the evaluation of next steps to be taken.
Treatment options for FBSS are dependent upon:

  • Thorough assessment using MRI, CT scan or other appropriate imaging techniques.

  • Consideration of the patient’s concurring health problems and extenuating life circumstances.

  • Medical history.

  • Physical examination.

Generally, treatment focuses on conservative measures first, such as rehabilitation and pain management, before another surgery is considered. Sometimes further surgery is not a consideration in the patient’s pain management future.

Treatment includes

1.   RACZ procedure (Epidural Adhesiolysis for epidural fibrosis)

2.   Facet joint block or Radio frequency medial branch rhizotomy for facet joint dysfunction,

3.   Sacroiliac joint block or Radio frequency rhizotomy for sacroiliac joint dysfunction,

4.   Nerve root block for persistent radiculopathy

5.   Ozone nucleolysis for recurrent or persistent herniation, spinal stenosis.

6.   Spinal cord stimulation - In many cases all these procedures may prove unsuccessful for long-term relief and spinal cord stimulation may prove beneficial and cost effective in the long run.

7.   Intrathecal Implantable pumps to deliver pain medicines

 

 
What is the sacroiliac joint?

 
The large, C-shaped sacroiliac (SI) joint connects the pelvic bones (the ilia) to the sacrum at the base of the spine. There are two SI joints, one on either side of the tailbone. Serving as shock absorbers for the pelvis and low back, the SI joints move constantly when the body is in motion, helping to provide stability and structural support to the lower part of the body.
 
The most common cause of SI joint dysfunction is from traumatic injury, whether from a fall or traffic accident or from repetitive rotation of the lumbar spine and pelvis during sports and work-related activities. The other most common cause is degenerative arthritis of the joint. Stretching, straining, and tearing of the primary SI joint ligaments then cause weakening and abnormal motion of the joint, resulting in painful ligaments and joints as well as spasm. Postural imbalances as well as leg length inequalities can also cause S.I. dysfunction. As a result of this, there is a disruption of movement in the joint (either too much or too little). There are many disorders that affect the joints of the body that can also cause inflammation in the S. I. joints. These include gout, rheumatoid arthritis, psoriasis, and ankylosing spondylitis. These are all various forms of arthritis that can affect all joints
 
Symptoms  - Most patients experience low back pain that is worsened by sitting, standing, and bending at the waist. Frequent changes in posture are needed. In severe cases, pain may also be felt in the hip, groin, and leg. These symptoms are the result of movements that are disrupted and overall dysfunction in the SI joint.
 

Diagnosis - Not all patients show obvious signs of SI joint dysfunction, and X-rays, MRIs, CT scans, and bone scans of the pelvis will generally be normal.

Therefore, identifying SI joint dysfunction requires obtaining a detailed medical history, analyzing the mechanism of injury, and conducting a comprehensive examination of the spine and pelvis.

In addition, the physician must be familiar with the signs of hypo-mobility and hyper-mobility of the SI joints and their role in low back pain. Your physician may also conduct fluoroscopic intra-articular injection and injection of the supporting ligaments in order to determine the diagnosis.
 

Management -Treatment can include a combination of the following:

  • Rehabilitation techniques (flexibility, core strengthening/stabilization, and joint manipulation)

  • Osteopathic manipulation techniques

  • Gait and posture retraining

  • Steroid and anesthetic injections

  • Prolotherapy (excellent for resistant or chronically recurring cases), which increases the strength of the SI joint ligaments and helps restore normal motion

  • Surgical fusion of the SI joint (a last resort, performed only in cases of severe debilitating instability)

Although the SI joint is a frequent source of pain in the low back and legs, SI joint dysfunction can be successfully treated by re-establishing normal positioning and function of the joint and the supporting structures through the conservative yet specialized approach outlined above.

 
Knee Pain
 
Knee pain is often age-related. In younger people, knee pain is more commonly caused by trauma or overuse, usually related to sports or some physical activity. If you are over 40 and have knee pain, the most likely reason is wear and tear in the knee joint, also known as degenerative arthritis or degenerative joint disease (DJD).
 
Osteoarthritis is the most common cause of knee pain.

Osteoarthritis (OA) is the gradual and painful deterioration of the articular cartilage and subchondral bone in your joint. When the cartilage thins, your bones rub against each other and the lining of your joints, which is full of nerves and sensitive to pain.

Osteoarthritis is more common in people over 40 and often develops earlier in former athletes who suffered knee injuries during their youth.

Its early symptoms are pain and stiffness in the morning or after strenuous activity. Morning stiffness usually resolves in less than an hour.

Management includes NSAIDS, opioids, physical therapy, injections of steroid, Prolotherapy & surgery in indicated patients.
Rheumatoid Arthritis is an inflammatory disease, triggered by the immune system, which affects millions of people worldwide.

Rheumatoid arthritis damages the cartilage and joint lining. The damaged tissue releases enzymes that damage the cartilage, soft tissues, and even bone.

No one knows what causes the immune system to begin attacking the body's joints. The problem tends to strike between the ages of 20 and 45, s more common in women, and usually affects many different joints in the body, not just the knees.

Early symptoms are fatigue, flu-like aching, joint pain, and morning stiffness that lasts longer than an hour.

Management includes disease modifying drugs, NSAIDS, opioids, physical therapy, injections of steroid, Prolotherapy & surgery in indicated patients.
Pseudogout occurs when the body forms calcium crystals that are deposited in joints, typically in the knees and wrists.

It usually strikes later in life. It can cause quick, severe pain but can produce long-term pain in about half the people it affects, appearing much like osteoarthritis.

Early symptoms are red and swollen joints, painful to touch, and sometimes fever in bad attacks.

Treatment usually consists of anti-inflammatory drugs, Prolotherapy or injections of steroids directly into the joint.
Bursitis of the knee occurs when the bursa, a fluid-filled sac that serves as a cushion between a bone and soft tissue, such as a tendon, becomes inflamed.

It can be caused by extensive kneeling, infection, or an injury to the knee and usually lasts a few weeks.

Early symptoms are pain and swelling just below the inside of the knee.

Treatment includes stretching and anti-inflammatory drugs, either pills, Prolotherapy or injection of steroids. Surgery is rarely needed.
Tendinopathies: overuse tendinopathies are numerous and quite common.

Numerous investigators worldwide have shown that the pathology underlying these conditions is tendinosis or collagen degeneration.

Painful overuse tendon conditions have a non-inflammatory pathology and therefore tendinitis is not a correct term.

Equally, anti-inflammatory drugs (NSAIDs) usually do not help. Prolotherapy is good option for treatment of such conditions.
Sports Injuries:

There are three common sports-related causes of knee pain: Runner's knee (overuse injuries), ligament injuries, and torn cartilage.

Runner's knee is caused by damage and inflammation of the tendons, which develops when you run, ski, or cycle too much or incorrectly. Symptoms are pain, and sometimes swelling, at the front of the knee.

Ligaments are tough bands of tissue connecting bones in your joints that can be stretched or torn when your knee is twisted or hit. Symptoms are immediate and severe pain. Don't attempt to walk on the leg until you've seen a doctor. The two pads of cartilage in your knee can be torn if you forcefully twist your knee while, for example, lunging for a tennis ball. Symptoms can include pain, swelling, locking of the knee, or clicking of the knee.

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