• Vincent J Heck, Bastian Himpe, Juan M Vinas-Rios, Tobias Prasse, Michael J Pflüger, Maximilian Lenz, Sven Schmidt, Paul Kessler, and Michael Rauschmann.
• Orthopedic University Hospital Friedrichsheim, University Hospital of Frankfurt, Marienburgstrasse 2, 60528, Frankfurt, Germany. vincent.heck@uk-koeln.de.
• Eur Spine J. 2023 Oct 1; 32 (10): 337033783370-3378.

PurposeTo 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.MethodsIn 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.ResultWe 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.ConclusionsThis 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.© 2023. The Author(s).

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