Aim: The aim of this thesis is both evaluate a somatognosis quality and consider rate of personality dimensions in patients with FBSS. Methods: 30 patients with FBSS and 25 probands of healthy control group were examinated in laboratory of spatial cognition called Blue Velvet Arena. They underwent spatial navigation task and body scheme tests. We made comparative analysis of these measurements between groups. We evaluated personality dimensions in patients group, by using NEO personality inventory and Petrie test. Finally we consider relationships of these variables and another related factors. Results: Signicant difference between patient's group and control group was found both in spatial navigation task and body scheme tests. In spatial navigation task control group had lower results compared to the patient's group. In body scheme tests was found reverse results. We found high correlation of body scheme with age, pain duration and activity level. There was high percentage of underestimating probands and probands with high score of conscientiousness. Error rate (judgement out of tolerance zone) was higher in patient's group compared to the control group. Conclusions: Our results states that patients with FBSS have lower quality of somatognosis in light of body scheme. We hypothesise, that body...

The current study was designed to test the effectiveness of spinal cord stimulation (SCS) in a retrospective group of 43 failed back surgery syndrome (FBSS) patients. A medical record review was conducted on study participants to capture · relevant presurgical biopsychosocial variables deemed to be of potential prognostic value. In addition, a multidimensional approach to outcome assessment was undertaken along three general domains: general health status, disease specific outcomes, and surgical outcomes. Descriptive statistics of presurgical variables and outcome measurements are provided as well as a model of outcome prediction based on these prognostic variables. Results suggest that the use of neurostimulation may help to reduce low back and/or leg pain in some patients with FBSS; however, a large number of patients reported continuing pain, physical disability, and inability to work despite treatment. The current study calls into question the efficacy of SCS for FBSS. Recommendations for future studies are presented.

Lumbal spinal stenos är ett av de vanligaste patologiska tillstånden i ryggen. Primärt mål för de flesta av interventionerna vid lumbal spinal stenos är en förbättring av gångförmågan. I det Svenska ryggregistret för uppföljning av kirurgi saknas utvärdering av objektivt uppmätt gångförmåga. Syfte: Att undersöka hur objektivt uppmätt gångförmåga påverkas efter en operation av lumbal spinal stenos samt hur den korrelerar mot subjektivt skattad gångförmåga och mot skattad rygghälsa samt livskvalitet. Metod: Etthundrasjuttiotre patienter i ålder 50-81 år utförde pre och 24 månader postoperativt ett standardiserat six minutes walk test (6 MWT) samt besvarade enkäter om självskattad gångförmåga, livskvalitet (EQ5D) och rygghälsa (ODI). Signifikans på förändring av medelvärdet av gångförmågan beräknades med ett parat t-test och 95 % konfidensintervall. Korrelation mellan uppmätt gångförmåga och självskattad gångförmåga samt mot EQ5D och ODI beräknades med Spearmans rangkorrelation. Resultat: Gångförmågan mätt med 6MWT förbättrades från 314 meter preoperativt till 396 meter 24 månader postoperativt. Korrelationen mellan uppmätt gångförmåga och självskattad gångförmåga var 0,68 postoperativt. Korrelationen mellan 6 MWT och EQ5D var 0,60 och mot ODI 0,65, 2 år postoperativt. Konklusion: Resultatet i denna studie visade på en signifikant förbättring av objektivt uppmätt gångförmåga två år efter en operation av lumbal spinal stenos. Korrelationen mellan självskattad gångförmåga och 6 MWT var moderat. Korrelationen mellan 6 MWT och EQ5D var moderat och moderat till stark mot ODI. / Lumbar spinal stenosis is one of the most common pathological conditions in the lower back. A primary goal for most of the interventions for lumbar spinal stenosis is an improvement of walking ability. In the Swedish back registry for follow-up surgery objectively measured gait is missing. Objective: To examine how objectively measured walking capacity is affected by an operation of lumbar spinal stenosis and how it correlates with subjective estimated walking capacity, back health (ODI) and quality of life (EQ5D). Method: Onehundredseventythree patients in age 50-81 years performed pre and 24 months postoperatively a standardized six minutes walk test (6 MWT) and responded to questionnaires about self-rated gait, EQ5D and ODI. Significance of the change in mean walking ability was calculated by using a paired t-test and 95% confidence intervals. Correlation between the measured gait and self-rated gait as well as against EQ5D and ODI were calculated with Spearman rank correlation. Result: Walking capacity measured by the 6MWT improved from 314 to 396 meters, 24 months postoperatively. The correlation between the measured and self-rated gait were 0,68 postoperatively. Correlation between 6MWT and EQ5D were 0,60 and against ODI 0.65, 2 years postoperatively. Conclusion: The results of this study showed a significant improvement in objectively measured walking capacity, two years after an operation of lumbar spinal stenosis. Correlation between self-rated gait and 6 MWT were moderate. Correlation between 6MWT and EQ5D were moderate and against ODI moderately strong.

O presente estudo avaliou a eficácia e a segurança da ozonioterapia (versus placebo) aplicados no espaço epidural através da epiduroscopia (endoscopia espinhal) em pacientes com síndrome dolorosa pós-laminectomia lombar (SDPL) acompanhados há mais de seis meses em tratamento no Centro Interdisciplinar de Dor do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Trata-se de um estudo piloto prospectivo, aleatorizado e duplamente encoberto. Os pacientes foram submetidos à epiduroscopia, utilizando-se um endoscópio espinhal introduzido através do hiato sacral, realizada a adesiólise mecânica e irrigação do espaço epidural com solução salina 0,9% e, no final, receberam o 20 mL (30?g/mL) da mistura O2-O3 (gás ozônio) ou o placebo (oxigênio a 100%) no espaço epidural lombar, mediante anestesia local e/ou sedação. Os pacientes foram avaliados antes do procedimento, com 24 horas, 30 dias, 3m, 6m e 12 meses após a intervenção por um pesquisador que não tinha conhecimento de qual produto fora injetado no espaço epidural lombar. Durante as avaliações, foram aplicadas as escalas de dor (EVA, McGill, DN4. NPSI, MQS e BPI), de qualidade de vida (WHOQO-Bref), inventário de depressão de Beck, IMG-P, e IMG-A e escalas de incapacidade física (Oswestry Disability Scale-ODI e Roland-Morris). Apenas um pesquisador manteve os dados em sigilo até o final do estudo. Foram estudados 43 pacientes, com idades entre 18 e 70 anos, divididos em subgrupos de acordo com a substância aplicada e a presença ou ausência de litígio trabalhista para análise dos dados. Vinte e três são do sexo masculino e 20 do sexo feminino, com idade média de 47,59 anos. Utilizou-se análise estatística com regressão multivariada e observou-se que a presença das variáveis litígio trabalhista, substância aplicada e dor neuropática influenciaram significativamente os escores do grupo submetido à epiduroscopia com ozônio e sem litígio trabalhista em cada teste aplicado. Observamos punções durais sem manifestações clínicas e um paciente com queixa de cefaleia após o procedimento. Este estudo mostra que a epiduroscopia com ozônio em pacientes com SDPL é aparentemente segura e revela tendência de efeitos positivos no período de 12 meses de seguimento, especialmente em pacientes com dor não neuropática e sem litígio trabalhista / This study evaluated the efficacy and safety of ozone therapy (versus placebo) applied into the epidural space through epiduroscopy (spinal endoscopy) in patients with failed back surgery syndrome (FBSS). This is a prospective, randomized, placebo-controlled and double blind study. We studied 43 patients of both sexes between 18 and 70 years with chronic low back pain persisting after surgery in the lumbar spine and for at least six months at the Interdisciplinary Pain Center, Hospital das Clínicas, Faculty of Medicine, University of São Paulo. Patients underwent epiduroscopy, using a spinal endoscope inserted through the sacral hiatus, performed mechanical adhesiolysis and irrigation of the epidural space with saline 0.9% and in the end received 20 mL (30?g/mL) of the mixture O2-O3 (ozone gas) or placebo (100% oxygen) in the lumbar epidural space, using local anesthesia and/or light sedation. Patients were evaluated before the procedure, with 24 hours, 30 days, 3, 6 and 12 months after intervention by a researcher who was unaware of which product was injected into the lumbar epidural space. During the evaluations, we applied the pain scales (EVA, McGill, DN4, NPSI, MQS e BPI), quality of life scales (WHOQOL) and physical disability scales (ODI and Roland-Morris). Only one researcher kept the data undisclosed until the end of the study. We studied 43 patients who were divided into groups according to the applied substance for data analysis. Twenty three were male and 20 female, with mean age of 47.59 years. Multivariate regression analysis pointed that the observed variables \"labor dispute\" (worker\'s compensation), \"substance applied\" and neuropathic pain influenced significantly the outcome of the group undergoing epiduroscopy with ozone and without litigation in each test. There were no side effects or complications observed. This study shows that epiduroscopy with ozone in patients with SDPL is apparently safe and trend reveals positive effects during the 12-month follow-up, especially in patients with non-neuropathic pain and without secondary compensations

O presente estudo avaliou a eficácia e a segurança da ozonioterapia (versus placebo) aplicados no espaço epidural através da epiduroscopia (endoscopia espinhal) em pacientes com síndrome dolorosa pós-laminectomia lombar (SDPL) acompanhados há mais de seis meses em tratamento no Centro Interdisciplinar de Dor do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Trata-se de um estudo piloto prospectivo, aleatorizado e duplamente encoberto. Os pacientes foram submetidos à epiduroscopia, utilizando-se um endoscópio espinhal introduzido através do hiato sacral, realizada a adesiólise mecânica e irrigação do espaço epidural com solução salina 0,9% e, no final, receberam o 20 mL (30?g/mL) da mistura O2-O3 (gás ozônio) ou o placebo (oxigênio a 100%) no espaço epidural lombar, mediante anestesia local e/ou sedação. Os pacientes foram avaliados antes do procedimento, com 24 horas, 30 dias, 3m, 6m e 12 meses após a intervenção por um pesquisador que não tinha conhecimento de qual produto fora injetado no espaço epidural lombar. Durante as avaliações, foram aplicadas as escalas de dor (EVA, McGill, DN4. NPSI, MQS e BPI), de qualidade de vida (WHOQO-Bref), inventário de depressão de Beck, IMG-P, e IMG-A e escalas de incapacidade física (Oswestry Disability Scale-ODI e Roland-Morris). Apenas um pesquisador manteve os dados em sigilo até o final do estudo. Foram estudados 43 pacientes, com idades entre 18 e 70 anos, divididos em subgrupos de acordo com a substância aplicada e a presença ou ausência de litígio trabalhista para análise dos dados. Vinte e três são do sexo masculino e 20 do sexo feminino, com idade média de 47,59 anos. Utilizou-se análise estatística com regressão multivariada e observou-se que a presença das variáveis litígio trabalhista, substância aplicada e dor neuropática influenciaram significativamente os escores do grupo submetido à epiduroscopia com ozônio e sem litígio trabalhista em cada teste aplicado. Observamos punções durais sem manifestações clínicas e um paciente com queixa de cefaleia após o procedimento. Este estudo mostra que a epiduroscopia com ozônio em pacientes com SDPL é aparentemente segura e revela tendência de efeitos positivos no período de 12 meses de seguimento, especialmente em pacientes com dor não neuropática e sem litígio trabalhista / This study evaluated the efficacy and safety of ozone therapy (versus placebo) applied into the epidural space through epiduroscopy (spinal endoscopy) in patients with failed back surgery syndrome (FBSS). This is a prospective, randomized, placebo-controlled and double blind study. We studied 43 patients of both sexes between 18 and 70 years with chronic low back pain persisting after surgery in the lumbar spine and for at least six months at the Interdisciplinary Pain Center, Hospital das Clínicas, Faculty of Medicine, University of São Paulo. Patients underwent epiduroscopy, using a spinal endoscope inserted through the sacral hiatus, performed mechanical adhesiolysis and irrigation of the epidural space with saline 0.9% and in the end received 20 mL (30?g/mL) of the mixture O2-O3 (ozone gas) or placebo (100% oxygen) in the lumbar epidural space, using local anesthesia and/or light sedation. Patients were evaluated before the procedure, with 24 hours, 30 days, 3, 6 and 12 months after intervention by a researcher who was unaware of which product was injected into the lumbar epidural space. During the evaluations, we applied the pain scales (EVA, McGill, DN4, NPSI, MQS e BPI), quality of life scales (WHOQOL) and physical disability scales (ODI and Roland-Morris). Only one researcher kept the data undisclosed until the end of the study. We studied 43 patients who were divided into groups according to the applied substance for data analysis. Twenty three were male and 20 female, with mean age of 47.59 years. Multivariate regression analysis pointed that the observed variables \"labor dispute\" (worker\'s compensation), \"substance applied\" and neuropathic pain influenced significantly the outcome of the group undergoing epiduroscopy with ozone and without litigation in each test. There were no side effects or complications observed. This study shows that epiduroscopy with ozone in patients with SDPL is apparently safe and trend reveals positive effects during the 12-month follow-up, especially in patients with non-neuropathic pain and without secondary compensations

Over the past several decades rates of spine surgeries in the U.S. have increased dramatically. Spinal fusion surgery rates, in particular, have grown exponentially despite being one of the most costly, invasive, and controversial methods for treating patients suffering from back conditions. Furthermore, lumbar fusion surgeries continue to be performed at increasing rates despite a lack of scientific evidence and consensus that they are cost-effective and produce better clinical outcomes than less radical treatment of lower back pain. As a result, large amounts of healthcare dollars continue to be invested in these costly procedures which are potentially dangerous and have questionable efficacy in terms of improving patient outcomes. Importantly, there is a lack of population studies in the literature on spinal fusion surgeries from a health services research perspective. Therefore, the present research is a population based study using an administrative database and includes patients of all ages and payer types. The data used in the present study come from the Florida Agency for Health Care Administration (AHCA) and include all hospitalizations in Florida in 2010. The objective of the study is to analyze the incidence of spinal fusion surgeries in Florida hospitals for patients of all ages and payer types by demographic variables to understand who gets these surgeries and for which conditions. The first null hypothesis is that there are no statistically significant predictors of the incidence of lumbar/lumbosacral, dorsal/dorsolumbar spinal fusion surgeries in Florida hospitals. Logistic regression was used to analyze the incidence of fusion surgeries. The binary dependent variable was coded as a "1" for all patients who were a case (i.e. they received one of the five procedure codes being studied in the present research) and a "0" for all patients who were controls (meaning they did not receive any of the five fusion procedure codes). Logistic regression was used to predict the probability of an observation being a "1" given the independent variables included in the model. Additionally, hospital charges were analyzed to understand the associated hospital charges with these surgeries. The second null hypothesis is that there are no statistically significant predictors of the charges of Lumbar/Lumbosacral, Dorsal/Dorsolumbar spinal fusion surgeries in Florida Hospitals. A mixed effects model was used to test this hypothesis and the fixed effects which were included in the model were gender, age, race, principal payer, and principal procedure. A mixed effects model was chosen due to the fact that cases who had surgeries performed at the same hospital are not independent and therefore the data were clustered on hospitals. A random intercept term was used to address this fact. SAS software was used to complete all of the analyses. In 2010, there were 16,236 Lumbar/Lumbosacral, Dorsal/Dorsolumbar fusion surgery cases in Florida hospitals that were included in the case population and 21,856 individuals included in the control population for a total of 38,092 included in the study population. An understanding of who is most likely to receive a fusion surgery, at what age, and for which diagnoses, as has been done here, is extremely important. This knowledge can help researchers, policy makers, and physicians alike. Comprehensive physician practice guidelines for performing fusion surgeries still do not exist in the year 2013; therefore, in order to have the greatest impact, the efforts for creating the guidelines should be focused on those individuals who are most likely to receive fusions as shown for the first time by the data analyzed here. Given the high incidence of these surgeries in Florida alone, the need for practice guidelines cannot be overstated. The total hospital charges in Florida hospitals for the 16,236 cases were $2,095,413,584. Despite having the same principal diagnoses and a similar number of additional diagnoses, patients who received a fusion surgery resulted in approximately three times the charges as those incurred by the controls. Overall, the high incidence and charges for fusion surgeries shown in this study emphasize the importance of having a better understanding of when these surgeries are justified and for which patients. Without comprehensive practice guidelines established through evidence-based research this is difficult, if not impossible, to accomplish. The diagnoses which are most prevalent and show the most inconsistencies between cases may be a good starting point for such guidelines.

Approximately one in five adults in the United States experiences chronic pain. Over the last 50 years, spinal cord stimulation has become increasingly recognized as a minimally invasive, efficacious treatment modality for the management of chronic pain. The authors report a case study of a 46-year-old female in the first documented spinal cord stimulation simultaneously targeting intractable neuropathic and visceral pain caused by post-laminectomy syndrome and chronic pancreatitis, respectively. This case study demonstrates near-total relief of the patient's neuropathic low back/leg pain and visceral epigastric pain, showing evidence of potential clinical usefulness for spinal cord stimulation as a treatment option in patients who present with a combination of visceral and somatic pain symptoms.