Failed back surgery syndrome: a new strategy by the epidural injection of MESNA

• Published in: Musculoskeletal surgery Vol. 102; no. 2; pp. 179 - 184
• Main Authors: Carassiti, M., Di Martino, A., Centonze, A., Quattrocchi, C. C., Caldaria, A., Agrò, F., Denaro, V.
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01-08-2018; Springer; Springer Nature B.V
• Subjects: Aged; Analgesics - therapeutic use; Back surgery; Disability Evaluation; Diskectomy; Drug Therapy, Combination; Failed Back Surgery Syndrome - diagnostic imaging; Failed Back Surgery Syndrome - drug therapy; Failed Back Surgery Syndrome - prevention & control; Female; Fibrosis - diagnostic imaging; Fibrosis - prevention & control; Free Radical Scavengers - administration & dosage; Free Radical Scavengers - therapeutic use; Humans; Injections; Injections, Epidural; Laminectomy; Lumbar Vertebrae - surgery; Magnetic Resonance Imaging; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Mesna - administration & dosage; Mesna - therapeutic use; Middle Aged; Original Article; Orthopedics; Prospective Studies; Reoperation; Surgical Orthopedics; Surgical outcomes; Tissue Adhesions - diagnostic imaging; Tissue Adhesions - pathology; Tissue Adhesions - prevention & control; MESNA; Failed back surgery syndrome; Peridural injection; Peridural fibrosis
• ISSN: 2035-5106; 2035-5114
• DOI: 10.1007/s12306-017-0520-x

Purpose
Evaluate the efficacy and safety of MESNA (sodium 2-mercaptoethanesulfonate) injection into the epidural space in the FBSS.
Methods
We designed a prospective phase II longitudinal study. Six consecutive patients were enrolled. Patients underwent one peridural injection per week for 3 weeks. NRS and ODI were investigated before and 48 h after injections, and at 1 week, 1 month and 2 months after the last procedures. Opioids intake is investigated before procedures and 1 week, 1 month and 3 months after the last procedures. Lumbosacral MRI is performed before the first procedure, at the end and 3 months after the last procedures.
Results
From baseline, at 3 months, NRS in standing, sitting and lying position improved, respectively, of 34.29, 30.56 and 26.47%; ODI improved of 20.3%; the average decrease in morphine intake was 20.54%. No difference in MR images was found. Conclusions Our preliminary results suggest that MESNA might be an efficacy alternative to common practice.