Optimizing the Management and Outcomes of Failed Back Surgery Syndrome: A Consensus Statement on Definition and Outlines for Patient Assessment

Abstract

Failed back surgery syndrome (FBSS) is a controversial term for identifying patients affected by new, recurrent, or persistent pain in the low back and/or legs following spinal surgery. The lack of a comprehensive standardized care pathway compromises the appropriate management of FBSS patients, which is associated with a heavy financial burden. An international panel of spine surgeons, neurosurgeons, and pain specialists with a particular interest in FBSS established the chronic back and leg pain (CBLP) network with the aim of addressing the challenges and barriers in the clinical management of FBSS patients by building a common transdisciplinary vision. Based on literature reviews, additional input from clinical expertise of multiple professional disciplines, and consensus among its members, the network attempted to provide recommendations on the management of patients with FBSS utilizing a multidisciplinary team (MDT) approach. The presentation of this work has been divided in two separate parts to enhance its clarity. This first paper, in favour of selecting appropriate validated tools to improve the FBSS patient assessment, focuses on FBSS taxonomy and its clinical implications for evaluation. Concise recommendations for assessment, treatment, and outcome evaluation using a MDT approach would be an important resource for specialists and nonspecialist clinicians who manage patients with FBSS, to improve decision-making, reduce variation in practice, and optimize treatment outcomes in this difficult-to-treat population.

Comparison of conventional, burst and high-frequency spinal cord stimulation on pain relief in refractory failed back surgery syndrome patients: study protocol for a prospective randomized double-blinded cross-over trial (MULTIWAVE study)

“…The pain should be refractory despite well-conducted conservative management and no further spine surgery required. For the purposes of this study, FBSS is defined as persistent or recurrent low back and leg pain of at least 6 months’ duration, following at least one decompression and/or fusion procedure [ 1 – 5 ]. The patient has persistent low back and leg pain despite other treatment (pharmacological, surgical, physical, or psychological therapies) that have been tried and did not prove satisfactory, are unsuitable, or are contraindicated for the subject, comprising documented neuropathic characteristics of the radicular and/or low back pain component (Neuropathic pain Diagnostic questionnaire (DN4): sensorimotor testing, clinical examination, pain characteristics, etc.…”

“…Failed back surgery syndrome (FBSS), defined by chronic back and/or leg pain after lumbosacral spine surgery [1][2][3][4][5], is reported for 5-55% of the patients post-operatively [6]. FBSS is characterized by mixed neuropathic and nociceptive pain components described as refractory.…”

Optimizing the Management and Outcomes of Failed Back Surgery Syndrome: A Proposal of a Standardized Multidisciplinary Team Care Pathway

“…The composition of the CBLP Network and the methodology used to develop the proposed standardized FBSS care pathway adhere to the outlines presented in our first paper on FBSS definition and guidelines for patient assessment [23]:Participants in the CBLP panel were selected based on their extensive clinical and scientific experience in managing FBSS patients with focus on representation of the three specialties that are most involved in the treatment of this patient population: orthopaedic surgery, neurosurgery, and pain medicine/anesthesiology. Invitations were sent to potential participants all over Europe and accepted prior to engagement in the panel.…”

“…The work is presented in a series of two papers. The first paper focused on the definition of FBSS and outlined the criteria for appropriate diagnosis, with recommendations of validated tools to improve patient assessment [23]. The goal of this paper is to present a standardized care pathway to support clinicians in their decision-making on how to assess, treat, and evaluate patients with FBSS from an MDT-based perspective.…”

Analysis of Subdural Injection During Lumbar Interlaminar Epidural Injection in Failed Back Surgery Syndrome

“…Persistent and recurrent back and leg pain following spinal surgery significantly limits everyday life activities [ 1 ]. Failed back surgery syndrome (FBSS) has many etiologies: including lesions to disc or facet area adjacent to the surgery site; persistent or recurrent neural compression; neuritis; fibrosis; hardware-associated pain; and psychosocial factors [ 2 , 3 , 4 , 5 ].…”