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« FBSS » et stimulation médullaire : résultats à long terme dans la littérature

  • Laurence AbeloosEmail author
  • Cristo Chaskis

Résumé

Le FBSS (Failed back surgery syndrome) consiste en la persistance de douleurs lombaires et/ou radiculaires après une ou plusieurs interventions du rachis bien menées par ailleurs. Ce syndrome conduit avec le temps à l’apparition de douleurs chroniques neuropathiques résultant de plusieurs facteurs : une compression majeure et/ou prolongée de la racine nerveuse au cours de la période préopératoire, la survenue d’une complication chirurgicale ou d’une lésion nerveuse intra-opératoire, le développement d’une fibrose périradiculaire réactionnelle postopératoire. Le FBSS est une pathologie fréquente. Elle concerne, selon les séries, 12 à 40 % des patients opérés du rachis [1, 2]. La stimulation médullaire a été décrite, pour la première fois1, par Shealy et al. à la fin des années 1960 [3]. Bien que de multiples indications aient été décrites dans la littérature, le FBSS constitue actuellement l’indication principale de ce traitement2. Elle est proposée aux patients après échec d’un traitement conservateur bien conduit sous réserve d’une évaluation pluridisciplinaire favorable. Le traitement se déroule en deux étapes. Dans un premier temps, une électrode est mise en place par voie percutanée3 ou chirurgicale4 afin de tester l’efficacité de la stimulation médullaire. Si celle-ci procure une réduction d’au moins 50 % de la symptomatologie douloureuse, le test est considéré positif5. Un boîtier de stimulation interne est dès lors implanté dans un second temps, le plus souvent sous anesthésie générale.

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Copyright information

© Springer-Verlag Paris 2014

Authors and Affiliations

  1. 1.Service de neurochirurgieCHU de CharleroiCharleroiBelgique

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