Introduction: Failed back surgery syndrome (FBSS) is one of causes chronic low back pain (about 1%). Treatment of FBSS is often very complicated and there is neccessary to use many analgetic methods. Recently neuromodulation methods have become unsubstitutable in treatment of the most complicated FBSS patients. Neuromodulation analgetic systems have been officially established in Czech Republic (CR) since May 2000. Na Homolce Hospital became pioneering of neuromodulation methods, especially neurostimulation analgetic treatment in CR. There were still established 89 neuromodulation systems at 74 patients. According to many studies FBSS is the most frequent diagnosis for implantation of neuromodulation analgetic systems. Methods and results: In this case report there is described very intricate state of chronic severy pain in patient with FBSS, who has been treated for long time (8,5 years) with neurostimulation analgetic systems. Problem with low back pain was found out in 12 years and it has been worsen since 28 years of age. After exhaustion standard treatment and after upward revaluation finding there was approached to the operation in the lumbosacral spine (remove prolapse L5/S1 l. dx.). After it yet realized 3 revisions and stabilizition in this space. Therefore there was manifested typical FBSS pain with both mixed pain in low back pain and lower extremities, mainly in right one (VAS 8–9). After exhaustion standard possibilities of treatment FBSS we approached to long-term intraspinal treatment. There were repeatedly established port systems with catheters introduced in epidural and later in intrathecal space with good analgetic effects, but with significant side effects. Therefore after introduction of neuromodulation treatment in CR we applied neuromodulation treatment. We decided to use neurostimulation radiofrequency system Mattrix with two epidural established electrodes. This system was changed into fully programmable subcutaneous system Synergy after one year. Neurostimulation system was running with good analgetic effect, but we had to resolve electrode complication with necessity of a revision. After power exhaustion of Synergy we decided to exchange for a rechargeable generator Restore again with good function and pain relief (VAS 3–5). Course was complicated by intricated necrosis in the area of generator, with necessity of a revision and at the end with necessity of generator ablation consequently as well as both electrodes for alimentary infection. Patient has now treated again with unsatisfactory combination of standard analgetic therapy and has been deciding about repeating of neurostimulation system Restore implantation. Conclusions: This patient is an example of very complicated state of FBSS, where neuromodulation (neurostimulation) offered the last possibility of treatment. But as it turns out it is not from far treatment simple and uneventful. To good account mastered those treatment be necessary correct patient selection, sufficient and high – quality care of patient, how before implantation, during implantation and after implantation with solving possible complications, then in subsequent endless postimplantation care. Question is a safety and ethical aspect of this treatment.

Nemocnice Na Homolce ARO Praha

Complicated treatment of failed back surgery syndrome patient with neurostimulation analgetic approaches: a case report

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