PMID- 37584698 OWN - NLM STAT- MEDLINE DCOM- 20231030 LR - 20240415 IS - 1432-0932 (Electronic) IS - 0940-6719 (Linking) VI - 32 IP - 10 DP - 2023 Oct TI - Severity of spinal degeneration does not affect the pain reduction under continuous epidural analgesia. PG - 3370-3378 LID - 10.1007/s00586-023-07858-3 [doi] AB - PURPOSE: To outline clinical effectiveness of continuous epidural analgesia (CEA) in patients with failed back surgery syndrome (FBSS) or lumbar spinal stenosis (LSS) depending on severity of spinal degeneration. METHODS: In this retrospective cohort study, all patients with FBSS or LSS who underwent CEA within an inpatient rehabilitation program were evaluated. The pain reduction was measured by VAS on an hourly basis. Substantial pain reduction was defined as a minimal clinically important difference (MCID) > 50%. Severity of spinal degeneration, side effects and patient-specific characteristics were documented. RESULT: We included a total of 148 patients with 105 patients suffering from FBSS and 48 with LSS. The average pain reduction was - 37.6 +/- 19.2 in FBSS and - 38.1 +/- 17.8 in LSS group (p < .001 and p < .001, respectively). In the FBSS group, sensory deficits (p = .047) and numbness (p = .002), and in the LSS group, a severe disability measured by ODI (38.2 +/- 15.4 vs. 57.3 +/- 11.3, p < .001) significantly contributed to a worse outcome. The severity of the spinal degeneration and psychological disorders did not affect the pain reduction in terms of MCID. CONCLUSIONS: This study provides new evidence about CEA in the treatment of FBSS and LSS. CEA provides a significant pain reduction even under intensified physiotherapeutic exercising in patients with severe spinal degeneration and a broad variety of secondary diagnoses. Neurologic deficits in case of FBSS and severe disability in case of LSS may be risk factors for less favorable outcome. CI - (c) 2023. The Author(s). FAU - Heck, Vincent J AU - Heck VJ AUID- ORCID: 0000-0002-2541-6032 AD - Orthopedic University Hospital Friedrichsheim, University Hospital of Frankfurt, Marienburgstrasse 2, 60528, Frankfurt, Germany. vincent.heck@uk-koeln.de. AD - Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. vincent.heck@uk-koeln.de. FAU - Himpe, Bastian AU - Himpe B AD - Orthopedic University Hospital Friedrichsheim, University Hospital of Frankfurt, Marienburgstrasse 2, 60528, Frankfurt, Germany. AD - Center for Spinal Surgery, St. Elisabethen-Krankenhaus Frankfurt, Ginnheimer Strasse 3, 60487, Frankfurt, Germany. FAU - Vinas-Rios, Juan M AU - Vinas-Rios JM AD - Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. AD - Center for Spinal Surgery, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany. FAU - Prasse, Tobias AU - Prasse T AD - Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. AD - Department of Neurological Surgery, University of Washington, Seattle, WA, USA. FAU - Pfluger, Michael J AU - Pfluger MJ AD - Orthopedic University Hospital Friedrichsheim, University Hospital of Frankfurt, Marienburgstrasse 2, 60528, Frankfurt, Germany. AD - Department of Surgery, Campus Charite Mitte | Campus Virchow Klinikum, Charite - Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Berlin, Germany. AD - Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA. FAU - Lenz, Maximilian AU - Lenz M AD - Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. FAU - Schmidt, Sven AU - Schmidt S AD - Center for Spinal Surgery, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany. FAU - Kessler, Paul AU - Kessler P AD - Orthopedic University Hospital Friedrichsheim, University Hospital of Frankfurt, Marienburgstrasse 2, 60528, Frankfurt, Germany. AD - Department of Anesthesiology, Intensive-Care Medicine and Pain Therapy, University Hospital of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. FAU - Rauschmann, Michael AU - Rauschmann M AD - Center for Spinal Surgery, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230816 PL - Germany TA - Eur Spine J JT - European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society JID - 9301980 SB - IM MH - Humans MH - *Analgesia, Epidural MH - Retrospective Studies MH - *Spinal Stenosis/complications/surgery/diagnosis MH - Treatment Outcome MH - *Failed Back Surgery Syndrome MH - Lumbar Vertebrae/surgery OTO - NOTNLM OT - Chronic spinal pain OT - Continuous epidural analgesia OT - Epidural catheter OT - Failed back surgery syndrome OT - Spinal stenosis EDAT- 2023/08/16 12:43 MHDA- 2023/10/30 06:47 CRDT- 2023/08/16 11:04 PHST- 2022/09/09 00:00 [received] PHST- 2023/07/07 00:00 [accepted] PHST- 2023/06/10 00:00 [revised] PHST- 2023/10/30 06:47 [medline] PHST- 2023/08/16 12:43 [pubmed] PHST- 2023/08/16 11:04 [entrez] AID - 10.1007/s00586-023-07858-3 [pii] AID - 10.1007/s00586-023-07858-3 [doi] PST - ppublish SO - Eur Spine J. 2023 Oct;32(10):3370-3378. doi: 10.1007/s00586-023-07858-3. Epub 2023 Aug 16.