Korean Medicinal Combination Treatments for Failed Back Surgery Syndrome: A Retrospective Case Series

Article information

Acupunct. 2015;32(2):217-227
1Department of Acupuncture & Moxibustion Medicine, Mokuri Neck&Back Oriental Medicine
2Department of Rehabilitation, Mokuri Neck&Back Oriental Medicine
3Department of Spine Center, Mokuri Neck&Back Oriental Medicine
4College of Oriental Medicine, Gachon University
*Corresponding author: College of Oriental Medicine, Gachon University, 1342, Seongnam-daero, Sujeong-gu, Seongnam-si, Gyeonggi-do, 461-701, Republic of Korea, Tel: +82-31-750-8724, E-mail: rockandmineral@gmail.com
Received 2015 May 13; Revised 2015 May 27; Accepted 2015 June 02.

Abstract

Objectives:

This study is an evaluation of the effectiveness of treatments combined with Korean medical methods, such as relaxative Chuna and Gangchuk herbal medicines, for patients with failed back surgery syndrome.

Methods:

In this study, medical records of ten patients who experienced failed back surgery syndrome and participated in intensive Korean medical treatment were reviewed. All patients received relaxative Chuna and acupuncture along with Gangchuk herbal medicines during hospitalization. Numeric rating scale(NRS) in the degree of 0 to 10, pain-free walking distance(PFWD) and oswestry disability index(ODI) were measured before and after treatments.

Results:

The patients were hospitalized for an average of 22 days. The average NRS of lumbar pain in all patients decreased from 7.7±1.6 to 3.2±2.2 and the average NRS decline of leg pain was from 7.7±1.7 to 3.2±2.2, both of which indicate statistical significance(p < 0.05). PFWD in all patients increased from 113.3 m to 798.1 m on average. The average ODI in all patients significantly improved from 63.9±7.0 to 43.9±6.9(p < 0.05).

Conclusions:

The treatments combined with Korean medical methods for failed back surgery syndrome patients are clinically effective and viable.

Fig. 1.

L-spine MRI(2011. 5. 11)

a: L3~L4 stenosis. b: L4~L5 PLIF

Fig. 2.

L-spine MRI(2013. 2. 12)

a: L3~L4 stenosis. b: L4~L5~S1 PLIF.

Fig. 3.

L-spine MRI(2013. 1. 5)

a: L3~L4 stenosis. b: L4~L5 laminectomy.

Fig. 4.

L-spine MRI(2013. 3. 25)

a: L4~L5 right foraminal stenosis. b: L4~L5 laminectomy.

Fig 5.

L-spine MRI(2013. 4. 12)

a: L4~L5 stenosis & spondylolisthesis Gr 1.

b: L4-L5 laminectomy.

Fig. 6.

L-spine MRI(2013. 8. 26)

a: L4~L5 stenosis & spondylolisthesis Gr 1. b: L4~L5 laminectomy.

Fig. 7.

L-spine MRI(2013. 9. 27)

a: L3~L4 stenosis. b~L5~S1 laminectomy.

Fig. 8.

L-spine MRI(2013. 9. 30)

a: L3~L4 stenosis. b: L4~L5 partial laminectomy at left.

Fig. 9.

L-spine MRI(2011. 1. 17)

a: L4~L5 stenosis. b: L4~L5 PLIF.

Fig. 10.

L-spine MRI(2013. 6. 13)

a: L4-L5 stenosis. b: T10, L1, L4 osteoplasty.

Fig. 11.

Changes of NRS(lumber) score before and after treatments

Fig. 12.

Changes of NRS(leg) score before and after treatments

Fig. 13.

Changes of PFWD before and after treatments

Fig. 14.

Changes of ODI before and after treatments

Fig. 15.

Box plot showing the changes of NRS(lumbar) score between before and after treatment

There is significant improvement(p<0.001).

*: represent the average of NRS(lumbar) score.

Fig. 16.

Box plot showing the changes of NRS(leg) score between before and after treatment

There is significant improvement(p<0.001).

*: represent the average of NRS(Leg) score.

Fig. 17.

Box plot showing the changes of PFWD between before and after treatment.

There isn’t statistically significance(p>0.05).

* represent the average of PFWD.

Fig. 18.

Box plot showing the changes of ODI between before and after treatment

There is significant improvement(p<0.001).

*: represent the average of ODI.

Characteristics of Subjects

Changes of Clinical before and after Korean Medical Combination Treatments

References

1. Chan CW, Peng P. Review article failed back surgery syndrome. Pain Medicine 2011;12(4):577–606.
2. Pheasant HC, Dyck P. Failed lumbar disc surgery: cause, assessement, treatment. Clinical Orthopaedics & Related Research 1982;164(4):93–109.
3. Kim BJ, Cho JT, Shin DH, Kim JH. Failed back surgery syndrome: etiology and the results of the treatment. Journal of Korean Spine Surg 1999;6(1):135–40.
4. Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychology 2007;26(1):1–9.
5. Coleman SD, Mackey S. Spinal cord stimulation compared with medical management for failed back surgery syndrome. Current Pain and Headache Reports 2009;13(1):1–2.
6. Hayek SM, Helm S, Benyamin RM, Singh V, Bryce DA, Smith HS. Effectiveness of spinal endoscopic adhesiolysis in post lumbar surgery syndrome: a systematic review. Pain Physician 2009;12(2):419–35.
7. Terao T, Ishii T, Tani S, Abe T. Combination therapy of radiofrequency lumbar facet joint denervation and epidural spinal cord stimulation for failed back surgery syndrome. Neurologia Medico-chirurgica 2011;51(11):805–09.
8. Rodrigues FF, Dozza DC, Oliveira CR, Castro RG. Failed back surgery syndrome: casuistic and etiology. Arq Neuropsiquiatr 2006;64(3-B):757–61.
9. Lee DW, Shin MS. Case series of 5 failed back surgery syndrome patients who were treated by direct moxibustion therapy. The Acupuncture 2011;28(3):233–44.
10. Lee JH, Min KS, Kim SY, Kim SJ. The case report on 3 case of conservative treatment on failed back surgery syndrome. The Jornal of Chuna Manual Medicine for Spine & Nerves 2010;5(2):57–68.
11. Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001;94(2):149–58.
12. Shin SU, Chung SH, Lee JS, Shin HD, Kim SS. The study for clinical measurement of pain. Dongguk J The Institute of Oriental Medicine 2000;8(2):25–46.
13. Davidson M, Keating J. Oswestry disability questionnaire(ODQ). Australian Journal of Physiotherapy 2005;51(4):270.
14. Mixter WJ, Ayer JB. Rupture of the intervertebral disc with involvement of the spinal canal. New England J Med 1934;211(5):210–15.
15. Song KJ, Park HJ. Analysis of repeat surgery in the low back disorders. J Korean Orthop Assoc 1998;33(4):1126–33.
16. Wiesel SW. The multiply operated lumbar spine. Instructional Course Lectures 1985;34:66–77.
17. Waddell G, Kummel EG, Lotto WN, Graham JD, Hall H, McCulloch JA. Failed lumber disc surgery and repeated surgery following industrial injuries. J Bone Joint Surg Am 1979;61(2):201–07.
18. Hwang JS, Lee DH, Park HS. The clinical study on the effects of moxibustion to FBSS(failed back surgery syndrome). The Acupuncture 2006;23(3):67–75.
19. Choi HS, Cha YY, Park WH, et al. The domestic trend of failed back surgery syndrome: definition, treatment trials and instruments for assessment. Journal of Korean Medicine Rehabilitation 2014;24(4):41–48.
20. Kim SP, Kim JH, Ryu HS, Chun HS, Shin JC. The clinical report on 1 case of failed back surgery syndrome who were diagnosed as the cauda equina syndrome using hominis placenta pharmacopuncture. The Acupuncture 2011;28(5):135–42.
21. Park SH, Ro HR, Kim TH, Park JY. The comparative study on the effect of bee venom pharmacopuncture treatment and Hwangryun pharmacopuncture treatment of cervical disc herniation. The Acupuncture 2013;30(3):117–24.
22. Ju MS, Jeong HU, Kim HG, et al. Anti-nociceptive and anti-inflammatory effects of geranii herba. Kor J Herbology 2010;25(3):97–101.
23. Shin JM, Kang MS, Song YK. A case report on hivd patient treated by conservative oriental medical treatment with Kyungkuen Chuna. The Jornal of Chuna Manual Medicine for Spine & Nerves 2008;3(1):83–94.
24. Mcgregor AH, Hughes SP. The evaluation of the surgical management of nerve root compression in patients with low back pain: part 1: the assessment of outcome. Spine 2002;27(13):1465–70.
25. Kim YT. Diagnostic approach of spinal stenosis. J Korean Soc Spine Surg 2000;7(1):106–13.

Article information Continued

Fig. 1.

L-spine MRI(2011. 5. 11)

a: L3~L4 stenosis. b: L4~L5 PLIF

Fig. 2.

L-spine MRI(2013. 2. 12)

a: L3~L4 stenosis. b: L4~L5~S1 PLIF.

Fig. 3.

L-spine MRI(2013. 1. 5)

a: L3~L4 stenosis. b: L4~L5 laminectomy.

Fig. 4.

L-spine MRI(2013. 3. 25)

a: L4~L5 right foraminal stenosis. b: L4~L5 laminectomy.

Fig 5.

L-spine MRI(2013. 4. 12)

a: L4~L5 stenosis & spondylolisthesis Gr 1.

b: L4-L5 laminectomy.

Fig. 6.

L-spine MRI(2013. 8. 26)

a: L4~L5 stenosis & spondylolisthesis Gr 1. b: L4~L5 laminectomy.

Fig. 7.

L-spine MRI(2013. 9. 27)

a: L3~L4 stenosis. b~L5~S1 laminectomy.

Fig. 8.

L-spine MRI(2013. 9. 30)

a: L3~L4 stenosis. b: L4~L5 partial laminectomy at left.

Fig. 9.

L-spine MRI(2011. 1. 17)

a: L4~L5 stenosis. b: L4~L5 PLIF.

Fig. 10.

L-spine MRI(2013. 6. 13)

a: L4-L5 stenosis. b: T10, L1, L4 osteoplasty.

Fig. 11.

Changes of NRS(lumber) score before and after treatments

Fig. 12.

Changes of NRS(leg) score before and after treatments

Fig. 13.

Changes of PFWD before and after treatments

Fig. 14.

Changes of ODI before and after treatments

Fig. 15.

Box plot showing the changes of NRS(lumbar) score between before and after treatment

There is significant improvement(p<0.001).

*: represent the average of NRS(lumbar) score.

Fig. 16.

Box plot showing the changes of NRS(leg) score between before and after treatment

There is significant improvement(p<0.001).

*: represent the average of NRS(Leg) score.

Fig. 17.

Box plot showing the changes of PFWD between before and after treatment.

There isn’t statistically significance(p>0.05).

* represent the average of PFWD.

Fig. 18.

Box plot showing the changes of ODI between before and after treatment

There is significant improvement(p<0.001).

*: represent the average of ODI.

Table 1.

Characteristics of Subjects

Age Sex HP Diagnosis before surgery Method of surgery Diagnosis Pain-free time(year) No. of surgery
Patient 1 78 M 13 L4/5 stenosis L4~L5 PLIF L3/4 stenosis 3 1
Patient 2 65 F 23 HIVD L4~L5~S1 PLIF L3~L4 stenosis 15 1
Patient 3 58 M 22 HIVD L4~L5 laminectomy L3~L4 stenosis 0.6 1
Patient 4 77 M 17 HIVD L4~L5 laminectomy L4~L5 right foraminal stenosis 0.6 1
Patient 5 81 F 28 Spondylolisthesis L4~L5 laminectomy L4~L5 stenosis & spondylolisthesis Gr 1 3 1
Patient 6 72 M 23 Spondylolisthesis L4~L5 Laminectomy L4~L5 stenosis & spondylolisthesis Gr 1 0.75 1
Patient 7 73 M 16 HIVD L5~S1 laminectomy L3~L4 stenosis 12 1
Patient 8 80 F 13 HIVD L4~L5 partial laminectomy at left L3~L4 stenosis 8 2
Patient 9 77 F 24 Stenosis L4~L5 PLIF L4~L5 stenosis 2 1
Patient 10 75 F 24 Compression fracture T10, L1, L4 osteoplasty L4~L5 stenosis 1 3

PLIF: posterior lumbar interbody fusion. HIVD: herniated inter vertebral disc. HP: hospitalization period

Table 2.

Changes of Clinical before and after Korean Medical Combination Treatments

NRS(lumbar) NRS(leg) PFWD(m) ODI
Before After Before After Before After Before After
Patient 1 5 1 5 1 20 72 55 38
Patient 2 10 7 10 7 500 3000 67 53
Patient 3 8 1 9 1 50 150 65 45
Patient 4 9 4 9 4 250 540 63 48
Patient 5 8 4 7 4 0 150 58 43
Patient 6 8 4 8 4 100 1071 72 54
Patient 7 5 1 5 1 100 2000 57 32
Patient 8 7 1 7 1 0 100 78 37
Patient 9 9 3 9 3 0 100 62 45
Patient 10 8 6 8 6 62 44
Mean 7.7±1.6 3.2±2.2 7.7±1.7 3.2±2.2 113.3 798.1 63.9±7.0 43.9±6.9
p-value* 5.83E−06 2.220E−05 0.0553 2.4676E−05
*

p-value by paired t-test in before and after treatment. NRS: numerical rating scale.

PFWD: pain-free walking distance(neurogenic claudication distance). ODI: oswestry disability index.