Prevalence, characteristics, and burden of failed back surgery syndrome: the influence of various residual symptoms on patient satisfaction and quality of life as assessed by a nationwide Internet survey in Japan

Shinsuke Inoue, Mitsuhiro Kamiya, Makoto Nishihara, Young-Chang P Arai, Tatsunori Ikemoto, Takahiro Ushida, Shinsuke Inoue, Mitsuhiro Kamiya, Makoto Nishihara, Young-Chang P Arai, Tatsunori Ikemoto, Takahiro Ushida

Abstract

We conducted a cross-sectional, Internet-based survey with a nationally representative sample of Japanese adults to assess the prevalence and characteristics of failed back surgery syndrome (FBSS). Data regarding the residual symptoms and patient satisfaction from an online survey of 1842 lumbar surgery patients revealed the prevalence of FBSS to be 20.6% (95% confidence interval [CI], 18.8-22.6). The prevalence of low back pain, dull ache, numbness, cold sensations, and paresthesia after surgery was 94.0%, 71.1%, 69.8%, 43.3%, and 35.3%, respectively. With a logistic regression model, severe residual low back pain (numerical rating scale 8-10), higher pain intensity, and multiple low back surgeries were strongly associated with FBSS, with odds ratios of 15.21 (95% CI, 7.79-29.7), 1.40 (95% CI, 1.32-1.49), and 1.87 (95% CI, 1.25-2.81), respectively. Respondents with FBSS had significantly lower EuroQol-5D (P<0.001) values and significantly higher scores on the Kessler six-item psychological distress scale (P<0.001), compared with the non-FBSS group. Our findings indicate that residual sensations have a significant effect on patient quality of life, similar to that of chronic low back pain. Precise presurgical provision of prognoses based on comprehensive epidemiologic data, as well as scrupulous attention to patient satisfaction and clinical progress may help reduce the incidence of FBSS.

Keywords: failed back surgery syndrome; numbness; patient satisfaction; prevalence; residual symptom.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of participant recruitment.
Figure 2
Figure 2
Clinical outcomes of five preoperative symptoms.
Figure 3
Figure 3
Patient satisfaction with lumbar spine surgery by surgical diagnosis.
Figure 4
Figure 4
(A) Patient satisfaction with lumbar spine surgery by surgical diagnosis. (B) Prevalence of FBSS in a Japanese population; and influence of FBSS on health-related quality of life and psychological distress. P-values by unpaired t-test: *P<0.001; **P<0.05. Abbreviations: EQ-5D, EuroQol-5 dimensions; FBSS, failed back surgery syndrome; K6, Kessler psychological distress scale.
Figure 5
Figure 5
Average outcome scores of residual symptoms.

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