Skip to main content
Top
Published in: European Spine Journal 7/2019

01-07-2019 | Back Pain | Original Article

Dextrose injections for failed back surgery syndrome: a consecutive case series

Authors: İlker Solmaz, Serkan Akpancar, Aydan Örsçelik, Özlem Yener-Karasimav, Deniz Gül

Published in: European Spine Journal | Issue 7/2019

Login to get access

Abstract

Purpose

Patients with chronic low back pain, who do not respond to conservative treatment methods, generally undergo surgical revision operations, and sometimes an undesirable condition called failed back surgery syndrome (FBSS) may be inevitable. Hereby, dextrose is one of the regenerative methods that has gained popularity in the treatment of many musculoskeletal problems, and we aimed to present and evaluate the outcomes of 5% dextrose for the treatment of FBSS.

Methods

It has been designed as a consecutive case series. A total of 79 patients with FBSS, who had minimum 6 months of symptoms and did not respond to 3 months of conservative methods between May 2014 and March 2016, participated in the study. Prolotherapy injections were applied in posterior and lateral approaches. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were used for the pre- and post-treatment evaluations. Patient satisfaction was assessed with using a 5-point Likert scale by phone contacting.

Results

There was statistically significant difference between repeated VAS and ODI measurements.

Conclusions

These results may be the first step giving a lead to an undiscovered field. This treatment method should be kept in mind for FBSS patients before giving a decision of revision surgery.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.
Appendix
Available only for authorised users
Literature
2.
go back to reference Schofferman J, Reynolds J, Herzog R et al (2003) Failed back surgery: etiology and diagnostic evaluation. Spine J 3(5):400–403CrossRefPubMed Schofferman J, Reynolds J, Herzog R et al (2003) Failed back surgery: etiology and diagnostic evaluation. Spine J 3(5):400–403CrossRefPubMed
4.
go back to reference Hussain A, Erdek M (2014) Interventional pain management for failed back surgery syndrome. Pain Pract 14:64–78CrossRefPubMed Hussain A, Erdek M (2014) Interventional pain management for failed back surgery syndrome. Pain Pract 14:64–78CrossRefPubMed
5.
go back to reference Choi HS, Chi EH, Kim MR et al (2014) Demographic characteristics and medical service use of failed back surgery syndrome patients at an integrated treatment hospital focusing on complementary and alternative medicine: a retrospective review of electronic medical records. Evid Based Complement Altern Med 2014:714389PubMedPubMedCentral Choi HS, Chi EH, Kim MR et al (2014) Demographic characteristics and medical service use of failed back surgery syndrome patients at an integrated treatment hospital focusing on complementary and alternative medicine: a retrospective review of electronic medical records. Evid Based Complement Altern Med 2014:714389PubMedPubMedCentral
6.
go back to reference Shapiro C (2014) The failed back surgery syndrome: pitfalls surrounding evaluation and treatment. Phys Med Rehabil Clin N Am 25(2):319–340CrossRefPubMed Shapiro C (2014) The failed back surgery syndrome: pitfalls surrounding evaluation and treatment. Phys Med Rehabil Clin N Am 25(2):319–340CrossRefPubMed
7.
go back to reference Hazard RG (2006) Failed back surgery syndrome: surgical and nonsurgical approaches. Clin Orthop Relat Res 443:228–232CrossRefPubMed Hazard RG (2006) Failed back surgery syndrome: surgical and nonsurgical approaches. Clin Orthop Relat Res 443:228–232CrossRefPubMed
8.
go back to reference Weir S, Samnaliev M, Kuo TC et al (2017) The rate of persistent post-operative pain (FBSS) in revision lumbar spinal surgery. Spine J 17(3):S10CrossRef Weir S, Samnaliev M, Kuo TC et al (2017) The rate of persistent post-operative pain (FBSS) in revision lumbar spinal surgery. Spine J 17(3):S10CrossRef
10.
go back to reference Seven MM, Ersen O, Akpancar S et al (2017) Effectiveness of prolotherapy in the treatment of chronic rotator cuff lesions. Orthop Traumatol Surg Res 103(3):427–433CrossRefPubMed Seven MM, Ersen O, Akpancar S et al (2017) Effectiveness of prolotherapy in the treatment of chronic rotator cuff lesions. Orthop Traumatol Surg Res 103(3):427–433CrossRefPubMed
11.
go back to reference Ersen O, Koca K, Akpancar S et al (2017) A randomized-controlled trial of prolotherapy injections in the treatment of plantar fasciitis. Turk J Phys Med Rehab 64(1):i–xiCrossRef Ersen O, Koca K, Akpancar S et al (2017) A randomized-controlled trial of prolotherapy injections in the treatment of plantar fasciitis. Turk J Phys Med Rehab 64(1):i–xiCrossRef
12.
go back to reference Akpancar S, Seven MM, Tuzun HY et al (2017) Current concepts of prolotherapy in orthopedic surgery. Arch Trauma Res 6(2):e40447 Akpancar S, Seven MM, Tuzun HY et al (2017) Current concepts of prolotherapy in orthopedic surgery. Arch Trauma Res 6(2):e40447
14.
go back to reference Reeves KD, Topol GA, Fullerton BD (2008) Evidence-based regenerative injection therapy (prolotherapy) in sports medicine. In: Seidelberg PH, Beutler PL (eds) The sports medicine resource manual. Saunders, Philadelphia, pp 611–619CrossRef Reeves KD, Topol GA, Fullerton BD (2008) Evidence-based regenerative injection therapy (prolotherapy) in sports medicine. In: Seidelberg PH, Beutler PL (eds) The sports medicine resource manual. Saunders, Philadelphia, pp 611–619CrossRef
15.
go back to reference Di Paolo S, Gesualdo L, Ranieri E, Grandaliano G, Schena FP (1996) High glucose concentration induces the overexpression of transforming growth factor-beta through the activation of a platelet-derived growth factor loop in human mesangial cells. Am J Pathol. 149(6):2095–2106PubMedPubMedCentral Di Paolo S, Gesualdo L, Ranieri E, Grandaliano G, Schena FP (1996) High glucose concentration induces the overexpression of transforming growth factor-beta through the activation of a platelet-derived growth factor loop in human mesangial cells. Am J Pathol. 149(6):2095–2106PubMedPubMedCentral
16.
go back to reference Murphy M, Godson C, Cannon S, Kato S, Mackenzie HS, Martin F et al (1999) Suppression subtractive hybridization identifies high glucose levels as a stimulus for expression of connective tissue growth factor and other genes in human mesangial cells. J Biol Chem. 274(9):5830–5834CrossRefPubMed Murphy M, Godson C, Cannon S, Kato S, Mackenzie HS, Martin F et al (1999) Suppression subtractive hybridization identifies high glucose levels as a stimulus for expression of connective tissue growth factor and other genes in human mesangial cells. J Biol Chem. 274(9):5830–5834CrossRefPubMed
17.
go back to reference Krump E, Nikitas K, Grinstein S (1997) Induction of tyrosine phosphorylation and Na+/H+ exchanger activation during shrinkage of human neutrophils. J Biol Chem 272(28):17303–17311CrossRefPubMed Krump E, Nikitas K, Grinstein S (1997) Induction of tyrosine phosphorylation and Na+/H+ exchanger activation during shrinkage of human neutrophils. J Biol Chem 272(28):17303–17311CrossRefPubMed
18.
go back to reference Lyftogt J (2008) Pain conundrums: which hypothesis? Central nervous system sensitization versus peripheral nervous system autonomy. Aust Musculoskelet Med 13(2):72 Lyftogt J (2008) Pain conundrums: which hypothesis? Central nervous system sensitization versus peripheral nervous system autonomy. Aust Musculoskelet Med 13(2):72
21.
go back to reference Yelland MJ, Glasziou PP, Bogduk N, et al (2004) Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine (Phila Pa 1976) 29(1):9–16 (discussion 16) CrossRef Yelland MJ, Glasziou PP, Bogduk N, et al (2004) Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine (Phila Pa 1976) 29(1):9–16 (discussion 16) CrossRef
22.
go back to reference Dagenais S, Yelland MJ, Del Mar C, Schoene ML (2007) Prolotherapy injections for chronic low-back pain. Cochrane Database Syst Rev. 18(2):CD004059. Dagenais S, Yelland MJ, Del Mar C, Schoene ML (2007) Prolotherapy injections for chronic low-back pain. Cochrane Database Syst Rev. 18(2):CD004059.
23.
go back to reference Guran S, Coban ZD, Karasimav O et al (2018) Dextrose solution used for prolotherapy decreases cell viability and increases gene expressions of angiogenic and apopitotic factors. Gulhane Med J 60:42CrossRef Guran S, Coban ZD, Karasimav O et al (2018) Dextrose solution used for prolotherapy decreases cell viability and increases gene expressions of angiogenic and apopitotic factors. Gulhane Med J 60:42CrossRef
24.
go back to reference Hackett GS, Hemwall GA, Montgomery GA (1993) Ligament and tendon relaxation treated by prolotherapy, 5th edn. Gustav A. Hemwall, Oak Park Hackett GS, Hemwall GA, Montgomery GA (1993) Ligament and tendon relaxation treated by prolotherapy, 5th edn. Gustav A. Hemwall, Oak Park
25.
26.
go back to reference Jamieson S (2004) Likert scales: how to (ab)use them. Med Educ 38(12):1217–1218 Jamieson S (2004) Likert scales: how to (ab)use them. Med Educ 38(12):1217–1218
27.
go back to reference Lee JH, Lee SH (2014) Clinical effectiveness of percutaneous adhesiolysis versus transforaminal epidural steroid injection in patients with postlumbar surgery syndrome. Reg Anesth Pain Med 39:214–218CrossRefPubMed Lee JH, Lee SH (2014) Clinical effectiveness of percutaneous adhesiolysis versus transforaminal epidural steroid injection in patients with postlumbar surgery syndrome. Reg Anesth Pain Med 39:214–218CrossRefPubMed
28.
go back to reference Hollingworth W, Turner JA, Welton NJ et al (2011) Costs and cost effectiveness of spinal cord stimulation (SCS) for failed back surgery syndrome. Spine 36:2076–2083CrossRefPubMed Hollingworth W, Turner JA, Welton NJ et al (2011) Costs and cost effectiveness of spinal cord stimulation (SCS) for failed back surgery syndrome. Spine 36:2076–2083CrossRefPubMed
29.
go back to reference Lad SP, Babu R, Bagley JH et al (2014) Utilization of spinal cord stimulation in patients with failed back surgery syndrome. Spine 39:E719–E727CrossRefPubMed Lad SP, Babu R, Bagley JH et al (2014) Utilization of spinal cord stimulation in patients with failed back surgery syndrome. Spine 39:E719–E727CrossRefPubMed
30.
go back to reference North RB, Kidd D, Shipley J et al (2007) Spinal cord stimulation versus reoperation for failed back surgery syndrome: a cost effectiveness and cost utility analysis based on a randomized, controlled trial. Neurosurgery 61:361–368CrossRefPubMed North RB, Kidd D, Shipley J et al (2007) Spinal cord stimulation versus reoperation for failed back surgery syndrome: a cost effectiveness and cost utility analysis based on a randomized, controlled trial. Neurosurgery 61:361–368CrossRefPubMed
31.
go back to reference Manchikanti L, Abdi S, Atluri S et al (2013) An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician 16:S49–283PubMed Manchikanti L, Abdi S, Atluri S et al (2013) An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician 16:S49–283PubMed
32.
go back to reference Chun-jing J, Hao-xiong N, Jia-ziang N (2012) The application of percutaneous lysis of epidural adhesions in patients with failed back surgery syndrome. Acta Cir Bras 27:357–362CrossRefPubMed Chun-jing J, Hao-xiong N, Jia-ziang N (2012) The application of percutaneous lysis of epidural adhesions in patients with failed back surgery syndrome. Acta Cir Bras 27:357–362CrossRefPubMed
33.
go back to reference Manchikanti L, Boswell MV, Datta S et al (2009) Comprehensive review of therapeutic interventions in managing chronic spinal pain. Pain Physician 12:E123–E198PubMed Manchikanti L, Boswell MV, Datta S et al (2009) Comprehensive review of therapeutic interventions in managing chronic spinal pain. Pain Physician 12:E123–E198PubMed
34.
go back to reference Fritsch EW, Heisel J, Rupp S (1996) The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments. Spine (Phila Pa 1976) 21: 626–633CrossRef Fritsch EW, Heisel J, Rupp S (1996) The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments. Spine (Phila Pa 1976) 21: 626–633CrossRef
35.
go back to reference Amirdelfan K, Webster L, Poree L et al (2017) Treatment options for failed back surgery syndrome patients with refractory chronic pain: an evidence based approach. Spine 42:S41–S52CrossRefPubMed Amirdelfan K, Webster L, Poree L et al (2017) Treatment options for failed back surgery syndrome patients with refractory chronic pain: an evidence based approach. Spine 42:S41–S52CrossRefPubMed
36.
go back to reference Louw A, Diener I, Landers MR et al (2014) Preoperative pain neuroscience education for lumbar radiculopathy: a multicenter randomized controlled trial with 1-year follow-up. Spine (Phila Pa 1976) 39:1449–1457CrossRef Louw A, Diener I, Landers MR et al (2014) Preoperative pain neuroscience education for lumbar radiculopathy: a multicenter randomized controlled trial with 1-year follow-up. Spine (Phila Pa 1976) 39:1449–1457CrossRef
37.
go back to reference Brox JI, Reikeras O, Nygaard O et al (2006) Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study. Pain 122:145–155CrossRefPubMed Brox JI, Reikeras O, Nygaard O et al (2006) Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study. Pain 122:145–155CrossRefPubMed
39.
go back to reference Thomson S, Jacques L (2009) Demographic characteristics of patients with severe neuropathic pain secondary to failed back surgery syndrome (PROCESS study). Pain Pract 9:206–214CrossRefPubMed Thomson S, Jacques L (2009) Demographic characteristics of patients with severe neuropathic pain secondary to failed back surgery syndrome (PROCESS study). Pain Pract 9:206–214CrossRefPubMed
40.
go back to reference Drucker M, Cardenas E, Arizti P et al (1998) Experimental studies on the effect of lidocaine on wound healing. World J Surg. 22(4):394–397 (discussion 397–8) CrossRefPubMed Drucker M, Cardenas E, Arizti P et al (1998) Experimental studies on the effect of lidocaine on wound healing. World J Surg. 22(4):394–397 (discussion 397–8) CrossRefPubMed
41.
go back to reference Kim MY, Na YM, Moon JH (1997) Comparison on treatment effects of dextrose water, saline, and lidocaine for trigger point injection. J Korean Acad Rehabil Med 21(5):967–973 Kim MY, Na YM, Moon JH (1997) Comparison on treatment effects of dextrose water, saline, and lidocaine for trigger point injection. J Korean Acad Rehabil Med 21(5):967–973
42.
go back to reference Rabago D, Kijowski R, Woods M et al (2013) Association between disease-specific quality of life and magnetic resonance imaging outcomes in a clinical trial of prolotherapy for knee osteoarthritis. Arch Phys Med Rehabil 94(11):2075–2082CrossRefPubMed Rabago D, Kijowski R, Woods M et al (2013) Association between disease-specific quality of life and magnetic resonance imaging outcomes in a clinical trial of prolotherapy for knee osteoarthritis. Arch Phys Med Rehabil 94(11):2075–2082CrossRefPubMed
43.
go back to reference Panjabi M, Abumi K, Duranceau J et al (1989) Spinal stability and intersegmental muscle forces. A biomechanical model. Spine 14(2):194–200PubMed Panjabi M, Abumi K, Duranceau J et al (1989) Spinal stability and intersegmental muscle forces. A biomechanical model. Spine 14(2):194–200PubMed
44.
go back to reference Clemente CD (1985) Gray’s Anatomy, 30th edn. Lea & Febiger, Philadelphia Clemente CD (1985) Gray’s Anatomy, 30th edn. Lea & Febiger, Philadelphia
45.
go back to reference Yelland M, Glasziou P, Bogduk N, Schluter P, McKernon M (2004) Prolotherapy injections, saline injections, and exercises for chronic low back pain: a randomized trial. Spine 29(1):9–16CrossRefPubMed Yelland M, Glasziou P, Bogduk N, Schluter P, McKernon M (2004) Prolotherapy injections, saline injections, and exercises for chronic low back pain: a randomized trial. Spine 29(1):9–16CrossRefPubMed
Metadata
Title
Dextrose injections for failed back surgery syndrome: a consecutive case series
Authors
İlker Solmaz
Serkan Akpancar
Aydan Örsçelik
Özlem Yener-Karasimav
Deniz Gül
Publication date
01-07-2019
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 7/2019
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-019-06011-3

Other articles of this Issue 7/2019

European Spine Journal 7/2019 Go to the issue