The goal was to prove that when a cohort of patients is chosen precisely, dorsal column stimulation provides significant improvement to quality of life. We studied a cohort of 50 patients with the history of failed back surgery syndrome coupled with epidural fibrosis (EF). A percutaneous implantation technique was used in each of the 50 patients. The study group was composed of 20 women and 28 men aged 26-67 years (mean age 49). A prospective observational questionnaire-based study was used. According to the methods, Ross's classification was adjusted to four degrees of scar size for our study objective. Despite this adjustment, it was not possible to statistically evaluate our research, due to very similar results in Groups I, III and IV. Patients without epidural fibrosis were assigned to Group 0, and patients with EF of different ranges were assigned to Group 1. The mean change in visual analogue scale DeltaVAS after our division into Group 0 was 4.82; for Group 1 it was 6.13. Evaluation of EF and DeltaVAS correlation by paired t-test shows a statistically higher effect of spinal cord stimulation (SCS) in the epidural fibrosis group, compared to group 0 without postoperative epidural fibrosis (p=0.008). The extent of epidural fibrosis is an important factor for Failed back surgery syndrome (FBSS). FBSS is the basis for the existence of neuropathic pain after lumbar spinal surgery. There is clear evidence of a correlation between patients with epidural scar formation on MR scan and the effect of dorsal column stimulation.

Department of Neurosurgery and Neurooncology 1st Faculty of Medicine Charles University Prague 6 Czech Republic

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ABELOOS L, De WITTE O, RIQUET R, TUNA T, MATHIEU N. Long-term outcome of patients treated with spinal cord stimulation for therapeutically refractory failed back surgery syndrome: a retrospective study. (Article in French) Neurochirurgie. 2011;57:114–119. doi: 10.1016/j.neuchi.2011.07.001. PubMed DOI

AKINDURO OO, MILLER BA, HAUSSEN DC, PRADILLA G, AHMAD FU. Complications of intraoperative epidural steroid use in lumbar discectomy: a systematic review and meta-analysis. Neurosurg Focus. 2015;39:E12. doi: 10.3171/2015.7.FOCUS15269. PubMed DOI

ALKALAY RN, KIM DH, URRY DW, XU J, PARKER TM, GLAZER PA. Prevention of postlaminectomy epidural fibrosis using bioelastic materials. Spine (Phila Pa 1976) 2003;28:1659–1665. doi: 10.1097/01.BRS.0000083161.67605.40. PubMed DOI

BARTYNSKI WS, PETROPOULOU KA. The MR imaging features and clinical correlates in low back pain-related syndromes. Magn Reson Imaging Clin N Am. 2007;15:137–154. doi: 10.1016/j.mric.2007.01.010. PubMed DOI

BOKOV A, ISTRELOV A, SKORODUMOV A, ALEYNIK A, SIMONOV A, MLYAVYKH S. An analysis of reasons for failed back surgery syndrome and partial results after different types of surgical lumbar nerve root decompression. Pain Physician. 2011;14:545–557. PubMed

CAMERON T. Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: a 20-year literature review. J Neurosurg. 2004;100(3 Suppl Spine):254–267. doi: 10.3171/spi.2004.100.3.0254. PubMed DOI

CINOTTI G, ROYSAM GS, EISENSTEIN SM, POSTACCHINI F. Ipsilateral recurrent lumbar disc herniation. J Bone Joint Surg Br. 1998;80:825–832. doi: 10.1302/0301-620X.80B5.0800825. PubMed DOI

CUI JG, O’CONNOR WT, UNGERSTEDT U, LINDEROTH B, MEYERSON BA. Spinal cord stimulation attenuates augmented dorsal horn release of excitatory amino acids in mononeuropathy via a GABAergic mechanism. Pain. 1997;73:87–95. doi: 10.1016/S0304-3959(97)00077-8. PubMed DOI

ERDOGAN H, KELTEN B, TUNCDEMIR M, ERTURKUNER SP, UZUN H, KARAOGLAN A. Hemostasis vs. epidural fibrosis?: A comparative study on an experimental rat model of laminectomy. Neurol Neurochir Pol. 2016;50:323–330. doi: 10.1016/j.pjnns.2016.05.002. PubMed DOI

FRITSCH EW, HEISEL J, RUPP S. The failed back surgery syndrome: Reasons, intraoperative findings, and long-term results: A report of 182 operative treatments. Spine. 1996;21:626–633. doi: 10.1097/00007632-199603010-00017. PubMed DOI

GÜVENÇ Y, YAMAN ME, ÖZTÜRK Y, ERGÜL G, ERBAY FK, TOLUNAY T, MENEKŞE G, ÖZCAN A, KAPTANOĞLU E. The prevention effect of N-acetylcysteine on epidural fibrosis in the postlaminectomy rat model. J Turk Spinal Surg. 2018;29:141–146.

HÄCKEL M, MASOPUST V, BOJAR M, GHALY Y, HORÍNEK D. The epidural steroids in the prevention of epidural fibrosis: MRI and clinical findings. Neuro Endocrinol Lett. 2009;30:51–55. PubMed

HOSSIENI B, DADKHAH P, MORADI S, HASHEMI SM, SAFDARI F. The results of treating failed back surgery syndrome by adhesiolysis: comparing the one- and three-day protocols. Anesth Pain Med. 2017;7:e60271. doi: 10.5812/aapm.60271. PubMed DOI PMC

KAPURAL L, YU C, DOUST MW, GLINER BE, VALLEJO R, SITZMAN BT, AMIRDELFAN K, MORGAN DM, BROWN LL, YEARWOOD TL, BUNDSCHU R, BURTON AW, YANG T, BENYAMIN R, BURGHER AH. Novel 10-kHz High-frequency Therapy (HF10 Therapy) Is Superior to Traditional Low-frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: The SENZA-RCT Randomized Controlled Trial. Anesthesiology. 2015;123:851–860. doi: 10.1097/ALN.0000000000000774. PubMed DOI

KAPURAL L, YU C, DOUST MW, GLINER BE, VALLEJO R, SITZMAN BT, AMIRDELFAN K, MORGAN DM, YEARWOOD TL, BUNDSCHU R, YANG T, BENYAMIN R, BURGHER AH. Comparison of 10-kHz High-Frequency and Traditional Low-Frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: 24-Month Results From a Multicenter, Randomized, Controlled Pivotal Trial. Neurosurgery. 2016;79:667–677. doi: 10.1227/NEU.0000000000001418. PubMed DOI PMC

KAYAOGLU CR, CALIKOĞLU C, BINLER S. Re-operation after lumbar disc surgery: results in 85 cases. J Int Med Res. 2003;31:318–323. doi: 10.1177/147323000303100410. PubMed DOI

KUMAR K, TAYLOR RS, JACQUES L, ELDABE S, MEGLIO M, MOLET J, THOMSON S, O’CALLAGHAN J, EISENBERG E, MILBOUW G, BUCHSER E, FORTINI G, RICHARDSON J, NORTH RB. The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow-up of the prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation. Neurosurgery. 63:762–770. doi: 10.1227/01.NEU.0000325731.46702.D9. discussion 770, 2008. PubMed DOI

LAD SP, BABU R, BAGLEY JH, CHOI J, BAGLEY CA, HUH BK, UGILIWENEZA B, PATIL CG, BOAKYE M. Utilization of spinal cord stimulation in patients with failed back surgery syndrome. Spine. 2014;39:E719. doi: 10.1097/BRS.0000000000000320. PubMed DOI

LAROCCA H, MACNAB I. The laminectomy membrane. J Bone Joint Surg Br. 1974;56B:545–550. doi: 10.1302/0301-620X.56B3.545. PubMed DOI

LINDEROTH B, FOREMAN RD. Physiology of spinal cord stimulation: review and update. Neuromodulation. 1999;2:150–164. doi: 10.1046/j.1525-1403.1999.00150.x. PubMed DOI

LIU Y, LI Y, MIAO J. Wound drains in posterior spinal surgery: a meta-analysis. J Orthop Surg Res. 2016;11:16. doi: 10.1186/s13018-016-0351-8. PubMed DOI PMC

MANCA A, KUMAR K, TAYLOR RS, JACQUES L, ELDABE S, MEGLIO M, MOLET J, THOMSON S, O’CALLAGHAN J, EISENBERG E, MILBOUW G, BUCHSER E, FORTINI G, RICHARDSON J, TAYLOR RJ, GOEREE R, SCULPHER MJ. Quality of life, resource consumption and costs of spinal cord stimulation versus conventional medical management in neuropathic pain patients with failed back surgery syndrome (PROCESS trial) Eur J Pain. 2008;12:1047–1058. doi: 10.1016/j.ejpain.2008.01.014. PubMed DOI

MANCHIKANTI L, SINGH V, CASH KA, PAMPATI V, DATTA S. Preliminary results of a randomized, equivalence trial of fluoroscopic caudal epidural injections in managing chronic low back pain: Part 3--Post surgery syndrome. Pain Physician. 2008;11:817–831. PubMed

MAROON J, ABLA A, BOST J. Association between peridural scar and persistent low back pain after lumbar discectomy. Neurol Res. 1999;21(Suppl 1):S43–S46. doi: 10.1080/01616412.1999.11741026. PubMed DOI

MASOPUST V, HÄCKEL M, NETUKA D, BRADÁC O, ROKYTA R, VRABEC M. Postoperative epidural fibrosis. Clin J Pain. 2009;25:600–606. doi: 10.1097/AJP.0b013e3181a5b665. PubMed DOI

MASOPUST V, HÄCKEL M, OSTRÝ S, NETUDA D, BENEŠ V. Administration of hyaluronidase in the treatment of postoperative epidural fibrosis: Results of treatment of 100 patients. Anest Intenziv Med. 2003;14:262–266.

MASOPUST V, PETRÍKOVÁ I, MLČEK M, HOLUBOVÁ J, ROKYTA R, FRICOVÁ J, JANOUŠKOVÁ K. Electrode movement prevention - an animal model. Physiol Res. 2019;68:667–673. doi: 10.33549/physiolres.933997. PubMed DOI

McCARRON RF, WIMPEE MW, HUDKINS PG, LAROS GS. The inflammatory effect of nucleus pulposus. A possible element in the pathogenesis of low-back pain. Spine (Phila Pa 1976) 1987;12:760–764. doi: 10.1097/00007632-198710000-00009. PubMed DOI

NORTH RB, KIDD D, SHIPLEY J, TAYLOR RS. Spinal cord stimulation versus reoperation for failed back surgery syndrome: a cost effectiveness and cost utility analysis based on a randomized, controlled trial. Neurosurgery. 2007;61:361–368. doi: 10.1227/01.NEU.0000255522.42579.EA. discussion 368–369. PubMed DOI

RENARD VM, NORTH RB. Prevention of percutaneous electrode migration in spinal cord stimulation by a modification of the standard implantation technique. J Neurosurg Spine. 2006;4:300–303. doi: 10.3171/spi.2006.4.4.300. PubMed DOI

ROBERTSON JT. Role of peridural fibrosis in the failed back: a review. Eur Spine J. 1996;5(Suppl 1):S2–S6. doi: 10.1007/BF00298565. PubMed DOI

ROKYTA R, LEJČKO J, HOUDEK K, TREFIL L, NEDVÍDEK J, FRICOVÁ J, HOLEČEK V. The glycation products before and after therapy for acute and chronic pain. Physiol Res. 2018;67(Suppl 4):S685–S688. doi: 10.33549/physiolres.933984. PubMed DOI

ROSS J, OBUCHOWSKI N, MODIC M. MR evaluation of epidural fibrosis: Proposed grading system with intra- and inter-observer variability. Neurol Res. 1999;21(Suppl 1):S23–S26. doi: 10.1080/01616412.1999.11758604. PubMed DOI

ROSS JS, OBUCHOWSKI N, ZEPP R. The postoperative lumbar spine: evaluation of epidural scar over a 1-year period. AJNR Am J Neuroradiol. 1998;19:183–186. PubMed PMC

ROSS JS, ROBERTSON JT, FREDERICKSON RCA, PETRIE JL, OBUCHOWSKI N, MODIC MT, DETRIBOLET N. Association between peridural scar and recurrent radicular pain after lumbar discectomy: Magnetic resonance evaluation. Neurosurgery. 1996;38:855–863. doi: 10.1227/00006123-199604000-00053. PubMed DOI

SEN O, KIZILKILIC O, AYDIN MV, YALCIN O, ERDOGAN B, CEKINMEZ M, CANER H, ALTINORS N. The role of closed-suction drainage in preventing epidural fibrosis and its correlation with a new grading system of epidural fibrosis on the basis of MRI. Eur Spine J. 2005;14:409–414. doi: 10.1007/s00586-004-0801-6. PubMed DOI PMC

SCHOLZ J, FINNERUP NB, ATTAL N, AZIZ Q, BARON R, BENNETT MI, BENOLIEL R, COHEN M, CRUCCU G, DAVIS KD, EVERS S, FIRST M, GIAMBERARDINO MA, HANSSON P, KAASA S, KORWISI B, KOSEK E, LAVAND’HOMME P, NICHOLAS M, NURMIKKO T, ET AL. The IASP classification of chronic pain for ICD-11: chronic neuropathic pain. Pain. 2019;160:53–59. doi: 10.1097/j.pain.0000000000001365. PubMed DOI PMC

SONG Z, ULTENIUS C, MEYERSON BA, LINDEROTH B. Pain relief by spinal cord stimulation involves serotonergic mechanisms: an experimental study in a rat model of mononeuropathy. Pain. 2009;147:241–248. doi: 10.1016/j.pain.2009.09.020. PubMed DOI

STILLER CO, CUI JG, O’CONNOR WT, BRODIN E, MEYERSON BA, LINDEROTH B. Release of gamma-aminobutyric acid in the dorsal horn and suppression of tactile allodynia by spinal cord stimulation in mononeuropathic rats. Neurosurgery. 1996;39:367–374. doi: 10.1097/00006123-199608000-00026. discussion 374–375. PubMed DOI

TAYLOR RS, RYAN J, O’DONNELL R, ELDABE S, KUMAR K, NORTH RB. The cost-effectiveness of spinal cord stimulation in the treatment of failed back surgery syndrome. Clin J Pain. 2010;26:463–469. doi: 10.1097/AJP.0b013e3181daccec. PubMed DOI

TEMEL SG, OZTURK C, TEMIZ A, ERSOZLU S, AYDINLI U. A new material for prevention of epidural fibrosis after laminectomy: oxidized regenerated cellulose (interceed), an absorbable barrier. J Spinal Disord Tech. 2006;19:270–275. doi: 10.1097/01.bsd.0000203946.11546.d9. PubMed DOI

TIAN F, DOU C, QI S, ZHAO L, CHEN B, YAN H, ZHANG L. Preventive effect of dexamethasone gelatin sponge on the lumbosacral epidural adhesion. Int J Clin Exp Med. 2015;8:5478–5484. PubMed PMC

WILLIAMSON A, HOGGART B. Pain: a review of three commonly used pain rating scales: Pain rating scales. J Clin Nurs. 2005;14:798–804. doi: 10.1111/j.1365-2702.2005.01121.x. PubMed DOI

YU CH, LEE JH, BAEK H-R, NAM H. The effectiveness of poloxamer 407-based new anti-adhesive material in a laminectomy model in rats. Eur Spine J. 2012;21:971–979. doi: 10.1007/s00586-011-2098-6. PubMed DOI PMC