Failed Back Surgery Syndrome: 5-Year Follow-Up in 102 Patients Undergoing Repeated Operation

Abstract

The indications for repeated operation in patients with persistent or recurrent pain after lumbosacral spine surgery are not well established. Long-term results have been reported infrequently, and in no case has mean follow-up exceeded 3 years. We report 5-year mean follow-up for a series of repeated operations performed between 1979 and 1983. Patient characteristics and modes of treatment have been assessed as predictors of long-term outcome. One hundred two patients with “failed back surgery syndrome” (averaging 2.4 previous operations), who underwent a repeated operation for lumbosacral decompression and/or stabilization, were interviewed by a disinterested third party a mean of 5.05 years postoperatively. Successful outcome (at least 50% sustained relief of pain for 2 years or at last follow-up, and patient satisfaction with the result) was recorded in 34% of patients. Twenty-one patients who were disabled preoperatively returned to work postoperatively; 15 who were working preoperatively became disabled or retired postoperatively. Improvements in activities of daily living were recorded, overall, as often as decrements. Loss of neurological function (strength, sensation, bowel and bladder control) was reported by patients more often than improvement. Most patients reduced or eliminated analgesic intake. Statistical analysis (including univariate and multivariate logistic regression) of patient characteristics as prognostic factors showed significant advantages for young patients and for female patients. Favorable outcome also was associated with a history of good results from previous operations, with the absence of epidural scar requiring surgical lysis, with employment before surgery, and with predominance of radicular (as opposed to axial) pain. These results suggest that selection criteria for repeated operation on the lumbosacral spine require further refinement, together with critical analysis of treatment outcome, and that alternative approaches to failed back surgery syndrome should be considered.

Reduction of epidural fibrosis after laminectomy in rabbits by omental free graft

“…In this condition scar tissue adheres to the dura mater or nerve roots are formed in order to repair the local defect of the vertebral lamina created by the laminectomy. However, this scar formation may be compressive and restrict the mobility of the nerve root which often leads to an unfavourable clinical outcome (North et al 1991;Songer et al 1995;Ross et al 1996). Concurrently epidural fibrosis increases the hazards of revision spine surgery and contributes to the occurrence of the "failed back surgery syndrome" (Robertson 1996;Ross et al 1996;Chan and Peng 2011).…”

Lower Limb Pain Caused by Insufficient Muscular Microcirculation

“…For the past two decades, researchers and practitioners have been using the phrase "FBSS" to describe patients with chronic disabling lower back pain with or without leg pain after one or more spinal surgeries [5]. However, studies with relevant outcome are rarely diagnosis specific, and high level research studies comparing surgical and nonsurgical approaches to FBSS studies have not been published to date [20].…”

“…Failed back surgery syndrome (FBSS) is clinically defined as persistent or recurrent pain, mainly in the lower back and/or legs, even after previous anatomically successful spinal surgery [5]. Some of the anatomic pain source is unclear, but lower limb perfusion insufficiency may induce the similar syndrome as neuropathic pain [6].…”

“…The success rates fall to around 30 % after a second back surgery, 15 % after the third, and to 5 % after the fourth surgery [8]. It is a disabling condition that affects approximately 30 % of spinal surgery patients and it is difficult to treat these patients with conservative therapy [5,9]. Patients with FBSS typically suffer many associated problems, including operations of the lumbosacral area, depression and sleeping problems, family and economic problems, high-dose opioid dependence, and low probability that further surgery will result in pain relief [10].…”

Honey can prevent epidural fibrosis development after laminectomy: an experimental study

“…The failed back surgery syndrome (FBSS) following lumbar disc herniation operations is reported in the literature at a rate of 5% to 40% (4,5,6,17). One of the most important causes of FBSS is the development of epidural fibrosis (EF).…”