The Failed Back Syndrome: Etiology and Therapy by Harold A. Wilkinson M.D., Ph.D. (auth.)

By Harold A. Wilkinson M.D., Ph.D. (auth.)

In the 8 years because the first version of this e-book a number of amazing technical advances became to be had clinically for the care of sufferers with "failed again syndromes. " excessive solution MRI scans, 3 size­ al CT scans, and percutaneous discectomy are outstanding technological advert­ vances. total, even though, the matter of "the failed again" is still as advanced and poorly understood as ever. A discouraging quantity of what we declare to be our wisdom of the pathophysiology and acceptable treatment for the complicated of issues that represent the failed again syndrome re­ mains unvalidated via cautious clinical learn. 1 The discussions of patho­ body structure, prognosis, and remedy positioned forth within the first variation for the main half stay both as legitimate or as debatable as they have been 8 years in the past. the 1st version used to be good bought by means of quite a few physicians and different overall healthiness care givers from quite a few disciplines and during them the publication turns out to have contributed usefully to a lot of those that undergo the disagreeable mal­ adies of "the failed again. " i am hoping this moment variation will likewise turn out to be a favorable contribution. The timing of the booklet of this moment version is important in different methods within the context of the present medicolegal weather within the United States.

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25 operations per patient-a frequency of surgery almost identical to that encountered by me in a series of over 800 patients operated on for lumbar disc disease. Thus, it remains unclear whether lumbar adhesive arachnoiditis develops as a result of disc rupture or whether it is in any way etiologically associated with myelography or disc surgery. It may be that a large percentage of cases, in fact, arise as a spontaneous disease and are simply misdiagnosed as lumbar disc ruptures. For these patients, of course, a failed back syndrome is the expected result if discectomy without intradural lysis is performed for a minimally bulging disc in the face of a large and atypical myelographic defect caused by primary arachnoiditis.

If depression is allowed to remain untreated and if no satisfactory relief of chronic pain is forthcoming, suicide becomes a distinct possibility. This is one of the clearly recognized complications of the failed back syndrome-a complication that, unfortunately, is not rare. Patients who express suicidal ideation, even if mentioned in apparent jest or by oblique reference, should be taken quite seriously in the hopes of preventing this "final solution" to chronic pain. Such patients should be challenged directly with the questions, "Are you planning to end your life?

9. Two surgically correctable causes of sciatica usually go undetected on myelography. Lateral recess stenosis, secondary to degenerative arthritic changes (left), and far lateral disc ruptures (right), cause nerve root entrapment within the neuroforamen with little or no encroachment upon the thecal sac. A CT scan may be diagnostic, but surgical confirmation often requires careful exploration through an adequate bony exposure. Facet Synovial Cysts While the facet syndrome of painful degeneration or instability causes predominantly low back pain with posterior thigh radiation, cysts derived from hypertrophied facet synovia that project into the spinal canal cause focal nerve root compression.

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