Moderators: Jerome Schofferman, MD and Alison Stout, DO
Failed back surgery includes a diverse group diagnoses with many different treatment options besides reoperation. There is not, however, a clear best practice for diagnosis and treatment of these conditions. There are specific diagnostic tools that provide more clear utility then others. With a more specific diagnosis, patients can and often do improve substantially once their treatment is matched to their diagnosis. Faculty will present an evidence-based approach that helps provide a means for more specific diagnosis with the most specific combination of clinical tools and to understand how different types of treatments have evidence for these patients.
Upon completion of this session, participants should gain strategies to:
- Appreciate how to use specific diagnostic tools to reach a more specific diagnosis for patients who have failed back surgery;
- Describe which tests are most helpful to reach a diagnosis;
- Distinguish specific treatments that have evidence with specific diagnoses related to failed back surgery.
Agenda
Differential Diagnosis Introduction
Alison A. Stout, DO
- Axial Pain
- Radicular Pain
- Extra-Spinal Causes
Use of Pain History
Jerome Schofferman, MD
- Comparison to Preoperative
- Topography and Mechanical Response
Physical Examination
Santhosh A. Thomas, DO, MBA
- Neurologic
- SIJ
- Movement Patterns
- Evaluation of Strength and Body Mechanics: PT Evaluation Considerations
Surgical Considerations
F. Todd Wetzel, MD
- Good Surgery
- Wrong Indication
- Patient
- Timing
- Good Indication
- Inadequate Technique
- Hardware Failure
Psychological Considerations
Jerome Schofferman, MD
Diagnostic Testing: Indications and Interpretation
Radiology
Charles H. Cho, MD, MBA
- Plain X-Rays: Hips
- MRI: Use of Contrast, Examples of Inadequate Decompression, Recurrent, Non-Fusion
- CT Scan if Needed, Especially to Evaluate Fusion and Placement of Internal Fixation
Electrodiagnostics
Alison A. Stout, DO
- EMG, Especially to Differentiate Spinal Problem versus Peripheral Neuropathy/Post-Surgical Plexopathy/Diabetic Amyotrophy and/or Entrapment
Diagnostic Injections: Clinical Pearls
Bryon J. Schneider, MD
- Medial Branch Blocks
- SIJ injections
- “Selective” Nerve Blocks, How Selective