1Associate Professor, Montreal University (CHUM), Montreal, Quebec. 2PGY 3 Orthopaedic Resident, Saint Joseph University, Beirut Lebanon. 3PGY 5 Montreal University, Montreal Quebec. 4Orthopedic Lecturer, Saint Joseph University, Beirut, Lebanon.
Abstract: “Lumbar spinal pain of unknown origin, either persisting despite surgical intervention or appearing after surgical intervention for spinal pain, originating in the same topographical location” is a description widely used to describe Failed Back Surgery Syndrome (FBSS). In reality, the syndrome is more often a mismatch between the patient’s expectations and the surgical results. This review will describe the possible causes and presentation of FBSS and highlight the role of the multidisciplinary team approach in its management involving non-operative and surgical interventions. The most important objective is correct patient selection for surgery before the first operation.
Key Words: Failed Back Surgery Syndrome, multi-disciplinary approach, spine surgery, low back pain, patient expectations.
Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.
1. Fusing even a short segment of the spine can have significant, possibly deleterious effects, on the complex spinal functions.
2. The Failed Back Syndrome is often a mismatch between the patient's expectations and the final result rather than a failure of surgical technique.
3. The poor result may be the result of preoperative, intraoperative or postoperative factors. All three areas must be assessed.
4. Correct patient selection is as important or even more important than the surgical approach.
The incidence of Failed Back Surgery Syndrome ranges from 10-40% after a major spinal operation.
Setting the preoperative expectations with a full discussion between the patient, referring physician and operating surgeon plays a key role.
There are three periods – pre-operative, intra-operative, post-operative–in which FBSS can arise.
Proper patient selection and pre-operative optimization of all modifiable factors improve outcomes and decrease the possibility of FBSS.
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A Study of Falls in Long-Term Care and the Role of Physicians in Multidisciplinary Evidence-Based Prevention
Victoria J. Scott, PhD, RN, Clinical Assistant Professor, School of Population and Public Health; Senior Advisor, Falls & Injury Prevention, BC Injury Research & Prevention Unit and Ministry of Healthy Living and Sport, Victoria, BC. S. Johnson, PhD, Professor, Faculty of Kinesiology and Health Studies, University of Regina, SK. J.F. Kozak, PhD, Assistant Professor, School of Population and Public Health, University of British Columbia; Director of Research Centre for Healthy Aging, Providence Health, Vancouver, BC. Elaine M. Gallagher, PhD, RN, Professor, School of Nursing; Director, Centre on Aging, University of Victoria, Victoria, BC.
Approximately one in two older adults living in long-term care (LTC) settings sustains a fall every year, resulting in significant human suffering and treatment costs. The complex set of factors that contribute to fall risk among this population demands a multidisciplinary approach to this problem, with physicians playing a pivotal role in risk assessment, prevention, and management. We describe a study where facility personnel from five LTC sites were trained in the use of a standardized surveillance tool to track falls, fall injuries, and contributing factors over 16-months. Using a pre-/post-test design, interventions included a multidisciplinary, evidence-based approach to fall risk assessment and monitoring, environmental modifications, exercise, and education strategies. Interventions by a multidisciplinary team, including physicians, were successful in reducing fall-related injuries and relatively successful in reducing the rate of falls among LTC residents. Further study is needed over a longer period of time, using a randomized control trial, to determine the effectiveness of specific interventions and to generalize findings to the larger population of LTC residents. Key words: fall prevention, long-term care, multidisciplinary approach, older adults.