Etiology, Evaluation, and Treatment of Failed Back Surgery Syndrome

The study aimed to review the etiology of failed back surgery syndrome (FBSS) and to propose a treatment algorithm based on a systematic review of the current literature and individual experience. FBSS is a term that groups the conditions with recurring low back pain after spine surgery with or without a radicular component. Since the information on FBSS incidence is limited, data needs to be retrieved from old studies. It is generally accepted that its incidence ranges between 10% and 40% after lumbar laminectomy with or without fusion. Although the etiology of FBSS is not completely understood, it is possibly multifactorial, and the causative factors may be categorized into preoperative, operative, and postoperative factors. The evaluation of patients with FBSS symptoms should ideally initiate with reviewing the patients' clinical history (observing “red flags”), followed by a detailed clinical examination and imaging (whole-body X-ray, magnetic resonance imaging, and computed tomography). FBSS is a complex and difficult pathology, and its accurate diagnosis is of utmost importance. Its management should be multidisciplinary, and special attention should be provided to cases of recurrent disc herniation and postoperative spinal imbalance.

Lumbar morphotypes analysis in a population of asymptomatic young adults: about 94 subjects

Introduction: Several studies suggest the importance of lumbar lordosis [LL] and pelvic parameters [PP] in sagittal balance and their central role in the discovertebral disorders. This radiographic study assesses pelvic parameters by sex and classifies lumbar morphotypes in a population of asymptomatic young subjects

Materials and methods: A sample of 95 asymptomatic young adults free of spinal pathology was recruited for a cross-sectional study. There were 54 men of which one was excluded and 41 women aged between 21 and 30 years. Each participant's pelvic incidence [PI], sacral slope [SS] pelvic tilt [PT] were measured from a lateral radiograph of the lumbar spine in a standing position. In addition, a classification using the 4 morphotypes of Roussouly was made

Results: There was no significant difference in the PI, SS or PT between men and women. The mean value was 51.34[degree sign], 39.85[degree sign] and 11.11[degree sign] for the PI, SS and PT respectively. In addition, 12.76% of the subjects were classified as type 1, 20.21% as type 2, 44.68% as type 3 and 22.34% as type 4

Conclusion: Analysis of this sample gives an idea of the prevalence of each morphotype among asymptomatic Lebanese young adults and the disco-vertebral pathologies that may result. More than half of the subjects are at risk of suffering from such diseases according to the study

Vertebral Augmentation: State of the Art

Osteoporotic vertebral compression fractures (OVF) are an increasing public health problem. Cement augmentation (vertebroplasty of kyphoplasty) helps stabilize painful OVF refractory to medical treatment. This stabilization is thought to improve pain and functional outcome. Vertebroplasty consists of injecting cement into a fractured vertebra using a percutaneous transpedicular approach. Balloon kyphoplasty uses an inflatable balloon prior to injecting the cement. Although kyphoplasty is associated with significant improvement of local kyphosis and less cement leakage, this does not result in long-term clinical and functional improvement. Moreover, vertebroplasty is favored by some due to the high cost of kyphoplasty. The injection of cement increases the stiffness of the fracture vertebrae. This can lead, in theory, to adjacent OVF. However, many studies found no increase of subsequent fracture when comparing medical treatment to cement augmentation. Kyphoplasty can have a protective effect due to restoration of sagittal balance.

particularites de la maladie de Scheuermann de l'adulte. A propos de 45 patients

Our aim was to find out which factors favor the occurrence of pain in adult patients with Scheuermann's disease -a juvenile manifestation of osteochondrosis of the spine, to study the clinical and radiological signs, the role of rehabilitation and the means to avoid the recurrence of pain. Patients and methods: Descriptive and retrospective study about 45 adults treated by rehabilitation. A data sheet listed the patient's occupation, current practice of sport, antecedents [violent sport, traumatism, pain], presence of a family form, motive of consultation, clinical and paraclinical examinations and immediate and long-term results of rehabilitation. Average age 35 years [18 to 65], male predominance [1.8: 1], occupational risk factors: 16%; only 24% practiced sports currently. Antecedents: sports 49%, spinal column traumatism 13%, dorsal and lumbar pain during adolescence 16%. Consultation motive: abnormal posture 4% and pain 96%.According to the examination: abnormal spinal column in 80% of cases. According to radiography, our patients were divided into 49% who were carriers of growth vertebral dystrophy and 51% who were carriers of the real Scheuermann's disease. The immediate results of rehabilitation were satisfactory, 75% of the results were very good and good. Between six months and four years, 70% of the results were very satisfactory. Exercises were observed in only 11% of the cases, and stopped after two months on average. Schcucrmann's disease in adults is a different entity from that of the teenager for the major manifestation is pain and not aesthetic quality. The patients occupation is rather sedentary; sport is beneficial. The functional rehabilitation is the basic treatment and recourse to surgery or dorso-lumbar braces is rare