Failed back (surgery) syndrome: time for a paradigm shift

Abstract

points 1. The group of patients with so-called 'failed back surgery syndrome' (FBSS) is very diverse. Published studies evaluating the outcome of surgical treatment vary widely in terms of surgical interventions that were performed. Results from these papers cannot be generally applied to all people who have persisting complaints after low back surgery. 2. The literature search that was performed demonstrated that the articles that scored as acceptable on assessment bias demonstrated a low to moderate patient-perceived recovery percentage. The only randomized controlled trial on this topic did not demonstrate a difference between instrumented fusion and cognitive intervention and exercise. 3. Current research does not show repeat surgery to be successful in 'FBSS patients', but clinical practice indicates that, in a small, carefully selected group, repeat surgery can yield rewarding results. However, parameters that make a patient prone to recover from a subsequent surgical intervention cannot be found in the literature. 4. The term 'failed back surgery syndrome' implies a causative role of surgery in a problem situation; failed back surgery syndrome is frequently regarded as failed back surgery. The literature does not, however, provide evidence for this. 5. It is important to inform the patient adequately to shape realistic expectations. Preoperative evaluation of parameters evaluating the psychological condition could help to better predict the outcome of surgery. 6. The term 'failed back surgery syndrome' has been demonstrated to be an ill-defined term, serving as a container for all kinds of back and leg problems, and wrongly implying a definite role for the surgical intervention in the aetiology. We suggest shifting the paradigm to 'failed back syndrome'. With this term we suggest defining those patients with back and radicular leg pain without a structural deficit, or with a structural deficit that has a low a priori chance of benefiting from a surgical intervention.

Piriformis Muscle Syndrome, Post Discectomy: a Comprehensive Review of its Diagnostic Process and Management, Illustrated with the Aid of a Case Report

“…The presence of red flags, despite their debated accuracy, was excluded through history taking and examination [4]. The persistence of pain despite appropriate surgical intervention is the basis of failed back surgery syndrome (FBSS) [5], which becomes the primary focus of the diagnosis [6]. Thus, the International Association for the Study of Pain (IASP) diagnosis [7] is:…”

“…Management of chronic pain and FBSS is best tackled with a BPS approach necessitating a multidisciplinary collaboration [6]. The NP component was treated with pregabalin [65].…”

“…If necessary booster sessions were made available to prevent or deal with relapses [100]. Therefore, this case was well managed through a multidisciplinary collaboration [6]. Treatment in its entirety was effective, and it followed an evidence-based procedure with an escalation of procedural interventions to gain better analgesia.…”

Perioperative intravenous low‐dose ketamine for neuropathic pain after major lower back surgery: A randomized, placebo‐controlled study

“…Worldwide, there is a significant increase in the overall number of spinal decompression and spinal fusion surgical procedures performed for degenerative lumbar spine disease (Martin et al, 2018;Sivasubramaniam, Patel, Ozdemir, Ozdemir, & Papadopoulos, 2015). Many of these patients suffer from chronic postoperative pain and nearly 20% of those undergoing spine surgery will require secondary surgery for persistent pain or surgery-related complications during subsequent years (Vleggeert-Lankamp, Arts, Jacobs, & Peul, 2013).…”

Does the Use of Epiduroscopic Lysis of Adhesions Reduce the Need for Spinal Cord Stimulation in Failed Back Surgery Syndrome? A Short‐Term Pilot Study

“…Persistent low back pain after initially successful surgery may be attributed to a wide variety of causes. 1 There may be structural deficits, such as recurrence of disc herniation or implant instability that can be treated by reoperation. When no structural instability is found, the condition is termed failed back surgery syndrome (FBSS).…”