1. Introduction: Etiology, Diagnosis, and Therapy.- Etiology.- Diagnostic and Therapeutic Approach.- 2. The Role of Improper Surgery in the Etiology of the Failed Back Syndrome.- Incorrect Diagnosis.- Unnecessary Surgery.- Improper or Inadequate Surgery.- 3. Symptomatic Diagnosis.- Low Back Pain.- Fusion Problems.- Leg Pain.- Psychogenic Factors.- Adhesive Arachnoiditis.- 4. Precise Diagnosis of Specific Syndromes.- History.- Physical Examination.- Laboratory Studies.- Electrodiagnostic Studies.- Noninvasive Radiologic Studies.- Invasive Radiologic Studies.- Radioactive Isotope Scans.- Diagnostic Injections.- 5. Noninvasive Therapy.- Enforced Inactivity Therapy.- Enforced Activity Therapy.- Topical and Transcutaneous Therapy.- Systemic Pharmacologic Therapy.- Psychological Therapy.- Chronic Pain Centers.- 6. Needle Therapy.- Corticosteroid and Anesthetic Injections of Local Tender Areas.- Prolotherapy.- Intradiscal Injections.- Facet Nerve and Joint Injections.- Sacroiliac Joint Injections.- Epidural Injections.- Intrathecal Injections.- Epidural, Paraspinal, and Intrathecal Radiofrequency Nerve Root Procedures.- Lumbar Sympathectomy.- 7. Surgical Therapy.- Repeat Laminectomy.- Repeat Spinal Fusion.- Primary Spinal Fusion.- Lysis of Arachnoiditis.- Excision of Local Tender Areas.- Dorsal Column Stimulator Implantation.- Implantation of Epidural or Subdural Catheters and Pumps.- Sensory Rhizotomy and Neurectomy.- Cordotomy and Myelotomy.- Brain-Stem Lesions and Stimulation.- Cingulotomy and Lobotomy.- 8. Team Approach or Individual Effort?.- References.- Suggested Readings.- Index of Case Reports.
In the eight years since the first edition of this book several marvelous technical advances have become available clinically for the care of patients with "failed back syndromes. " High resolution MRI scans, three dimension al CT scans, and percutaneous discectomy are notable technological ad vances. Overall, however, the problem of "the failed back" remains as complex and poorly understood as ever. A discouraging amount of what we claim to be our knowledge of the pathophysiology and appropriate therapy for the complex of disorders that constitute the failed back syndrome re mains unvalidated by careful scientific study. 1 The discussions of patho physiology, diagnosis, and therapy put forth in the first edition for the most part remain equally as valid or as controversial as they were eight years ago. The first edition was well received by numerous physicians and other health care givers from a variety of disciplines and through them the book seems to have contributed usefully to many of those who suffer the unpleasant mal adies of "the failed back. " I hope this second edition will likewise prove to be a positive contribution. The timing of the publication of this second edition is significant in several ways in the context of the current medicolegal climate in the United States.
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