Failed back surgery syndrome: current perspectives

Zafeer Baber, Michael A Erdek, Zafeer Baber, Michael A Erdek

Abstract

The treatment of failed back surgery syndrome (FBSS) can be equally challenging to surgeons, pain specialists, and primary care providers alike. The onset of FBSS occurs when surgery fails to treat the patient's lumbar spinal pain. Minimizing the likelihood of FBSS is dependent on determining a clear etiology of the patient's pain, recognizing those who are at high risk, and exhausting conservative measures before deciding to go into a revision surgery. The workup of FBSS includes a thorough history and physical examination, diagnostic imaging, and procedures. After determining the cause of FBSS, a multidisciplinary approach is preferred. This includes pharmacologic management of pain, physical therapy, and behavioral modification and may include therapeutic procedures such as injections, radiofrequency ablation, lysis of adhesions, spinal cord stimulation, and even reoperations.

Keywords: back pain; back pain with radiation; back pain without radiation; low back pain; pain disorder; review; spinal cord stimulation.

Conflict of interest statement

The authors declare no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Sacroiliac joint injection. Notes: Characteristic lateral (A) and AP (B) intra-articular sacroiliac joint (SIJ) injection. SIJ pain frequently occurs with lumbosacral fusion. The procedure can be used for both diagnostic and therapeutic purposes. Abbreviation: AP, anteroposterior.
Figure 2
Figure 2
Facet joint interventions. Notes: Fluoroscopic images of intra-articular facet blocks (A) and a lumbar medial branch block (B). Both the procedures are used as a prognostic indicator for a medial branch radiofrequency ablation. Debate as to which procedure is more accurate remains controversial.

References

    1. Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968–974.
    1. Smith M, Davis MA, Stano M, Whedon JM. Aging baby boomers and the rising cost of chronic back pain: secular trend analysis of longitudinal Medical Expenditures Panel Survey data for years 2000 to 2007. J Manipulative Physiol Ther. 2013;36(1):2–11.
    1. Rajaee SS, Bae HW, Kanim LE, Delamarter RB. Spinal fusion in the United States: analysis of trends from 1998 to 2008. Spine. 2012;37(1):67–76.
    1. Harvey AM. Classification of chronic pain – descriptions of chronic pain syndromes and definitions of pain terms. Clin J Pain. 1995;11(2):163.
    1. Thomson S. Failed back surgery syndrome – definition, epidemiology and demographics. Br J Pain. 2013;7(1):56–59.
    1. Parker SL, Mendenhall SK, Godil SS, Sivasubramanian P, Cahill K, Ziewacz J, McGirt MJ. Incidence of low back pain after lumbar discectomy for herniated disc and its effect on patient-reported outcomes. Clin Orthop Relat Res. 2015;473(6):1988–1999.
    1. Skolasky RL, Wegener ST, Maggard AM, Riely LH., 3rd The impact of reduction of pain after lumbar spine surgery: the relationship between changes in pain and physical function and disability. Spine. 2014;39(17):1426–1432.
    1. Burton CV, Kirkaldy-Willis WH, Yong-Hing K, Heithoff KB. Causes of failure of surgery on the lumbar spine. Clin Orthop Relat Res. 1981;157:191–199.
    1. Schofferman J, Reynolds J, Herzog R, Covington E, Dreyfuss P, O’Neill C. Failed back surgery: etiology and diagnostic evaluation. Spine J. 2003;3(5):400–403.
    1. Waguespack A, Schofferman J, Slosar P, Reynolds J. Etiology of long-term failures of lumbar spine surgery. Pain Med. 2002;3(1):18–22.
    1. Slipman CW, Shin CH, Patel RK, et al. Etiologies of failed back surgery syndrome. Pain Med. 2002;3(3):200–214.
    1. Kuniya H, Aota Y, Kawai T, Kaneko K, Konno T, Saito T. Prospective study of superior cluneal nerve disorder as a potential cause of low back pain and leg symptoms. J Orthop Surg Res. 2014;9(1):1.
    1. Gum JL, Glassman SD, Carreon LY. Is type of compensation a predictor of outcome after lumbar fusion? Spine. 2013;38(5):443–448.
    1. Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Clinical depression is a strong predictor of poor lumbar fusion outcomes among workers’ compensation subjects. Spine. 2015;40(10):748–756.
    1. Nguyen TH, Randolph DC, Talmage J, Succop P, Travis R. Long-term outcomes of lumbar fusion among workers’ compensation subjects: a historical cohort study. Spine. 2011;36(4):320–331.
    1. Sandén B, Försth P, Michaëlsson K. Smokers show less improvement than nonsmokers two years after surgery for lumbar spinal stenosis: a study of 4555 patients from the Swedish spine register. Spine. 2011;36(13):1059–1064.
    1. Krueger JK, Rohrich RJ. Clearing the smoke: the scientific rationale for tobacco abstention with plastic surgery. Plast Reconstr Surg. 2001;108(4):1063–1073.
    1. Fang A, Hu SS, Endres N, Bradford DS. Risk factors for infection after spinal surgery. Spine. 2005;30(12):1460–1465.
    1. Glassman SD, Anagnost SC, Parker A, Burke D, Johnson JR, Dimar JR. The effect of cigarette smoking and smoking cessation on spinal fusion. Spine. 2000;25(20):2608–2615.
    1. Marquez-Lara A, Nandyala SV, Sankaranarayanan S, Noureldin M, Singh K. Body mass index as a predictor of complications and mortality after lumbar spine surgery. Spine. 2014;39(10):798–804.
    1. Menendez ME, Neuhaus V, Bot AG, Ring D, Cha TD. Psychiatric disorders and major spine surgery: epidemiology and perioperative outcomes. Spine. 2014;39(2):E111–E122.
    1. McKillop AB, Carroll LJ, Battié MC. Depression as a prognostic factor of lumbar spinal stenosis: a systematic review. Spine J. 2014;14(5):837–846.
    1. Young AK, Young BK, Riley LH, 3rd, Skolasky RL. Assessment of presurgical psychological screening in patients undergoing spine surgery: use and clinical impact. J Spinal Disord Tech. 2014;27(2):76–79.
    1. Arts MP, Kols NI, Onderwater SM, Peul WC. Clinical outcome of instrumented fusion for the treatment of failed back surgery syndrome: a case series of 100 patients. Acta Neurochir. 2012;154(7):1213–1217.
    1. Unoki E, Abe E, Murai H, Kobayashi T, Abe T. Fusion of multiple segments can increase the incidence of sacroiliac joint pain after lumbar or lumbosacral fusion. Spine. 2015 Dec 18; Epub.
    1. Katz V, Schofferman J, Reynolds J. The sacroiliac joint: a potential cause of pain after lumbar fusion to the sacrum. J Spinal Disord Tech. 2003;16(1):96–99.
    1. Rigoard P, Blond S, David R, Mertens P. Pathophysiological characterisation of back pain generators in failed back surgery syndrome (part B) Neurochirurgie. 2015;61(Suppl 1):S35–S44.
    1. Hsu E, Atanelov L, Plunkett AR, Chai N, Chen Y, Cohen SP. Epidural lysis of adhesions for failed back surgery and spinal stenosis: factors associated with treatment outcome. Anesth Analg. 2014;118(1):215–224.
    1. Zdeblick TA, David SM. A prospective comparison of surgical approach for anterior L4–L5 fusion: laparoscopic versus mini anterior lumbar interbody fusion. Spine. 2000;25(20):2682–2687.
    1. Mobbs RJ, Sivabalan P, Li J. Minimally invasive surgery compared to open spinal fusion for the treatment of degenerative lumbar spine pathologies. J Clin Neurosci. 2012;19(6):829–835.
    1. Chan C-w, Peng P. Failed back surgery syndrome. Pain Medicine. 2011;12(4):577–606.
    1. Cohen SP, Huang JHY, Brummett C. Facet joint pain—advances in patient selection and treatment. Nat Rev Rheumatol. 2013;9(2):101–116.
    1. Shapiro CM. The failed back surgery syndrome: pitfalls surrounding evaluation and treatment. Phys Med Rehabil Clin N Am. 2014;25(2):319–340.
    1. Assaker R, Zairi F. Failed back surgery syndrome: to re-operate or not to re-operate? A retrospective review of patient selection and failures. Neurochirurgie. 2015;61(Suppl 1):S77–S82.
    1. Kizilkilic O, Yalcin O, Sen O, Aydin MV, Yildirim T, Hurcan C. The role of standing flexion-extension radiographs for spondylolisthesis following single level disk surgery. Neurol Res. 2007;29(6):540–543.
    1. Desai MJ, Nava A, Rigoard P, Shah B, Taylor RS. Optimal medical, rehabilitation and behavioral management in the setting of failed back surgery syndrome. Neurochirurgie. 2015;61(Suppl 1):S66–S76.
    1. Babar S, Saifuddin A. MRI of the post-discectomy lumbar spine. Clin Radiol. 2002;57(11):969–981.
    1. Eun SS, Lee HY, Lee SH, Kim KH, Liu WC. MRI versus CT for the diagnosis of lumbar spinal stenosis. J Neuroradiol. 2012;39(2):104–109.
    1. Hussain A, Erdek M. Interventional pain management for failed back surgery syndrome. Pain Practice. 2014;14(1):64–78.
    1. Datta S, Manchikanti L, Falco FJ, et al. Diagnostic utility of selective nerve root blocks in the diagnosis of lumbosacral radicular pain: systematic review and update of current evidence. Pain Physician. 2013;16(2 Suppl):SE97–S124.
    1. Beynon R, Hawkins J, Laing R, et al. The diagnostic utility and cost-effectiveness of selective nerve root blocks in patients considered for lumbar decompression surgery: a systematic review and economic model. Health Technol Assess. 2013;17(19):1–88.
    1. Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013;13(1):99–116.
    1. Diebo BG, Passias PG, Marascalchi BJ, Jalai CM, Worley NJ, Errico TJ, Lafage V. Primary versus revision surgery in the setting of adult spinal deformity: a nationwide study on 10,912 patients. Spine. 2015;40(21):1674–1680.
    1. Delitto A, Piva SR, Moore CG, et al. Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med. 2015;162(7):465–473.
    1. Keller A, Brox JI, Gunderson R, Holm I, Friis A, Reikerås O. Trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain randomized to lumbar fusion or cognitive intervention and exercises. Spine. 2004;29(1):3–8.
    1. Cramer H, Haller H, Lauche R, Dobos G. Mindfulness-based stress reduction for low back pain. a systematic review. BMC Complement Altern Med. 2012;12(1):162.
    1. Cho Y-H, Kim CK, Heo KH, et al. Acupuncture for acute postoperative pain after back surgery: a systematic review and meta-analysis of randomized controlled trials. Pain Pract. 2015;15(3):279–291.
    1. Marineo G, Iorno V, Gandini C, Moschini V, Smith TJ. Scrambler therapy may relieve chronic neuropathic pain more effectively than guideline-based drug management: results of a pilot, randomized, controlled trial. J Pain Symptom Manage. 2012;43(1):87–95.
    1. Khosravi MB, Azemati S, Sahmeddini MA. Gabapentin versus naproxen in the management of failed back surgery syndrome; a randomized controlled trial. Acta Anæsthesiol Belg. 2014;65(1):31–37.
    1. Canos A, Cort L, Fernández Y, Rovira V, Pallarés J, Barberá M, Morales-Suárez-Varela M. Preventive analgesia with pregabalin in neuropathic pain from “failed back surgery syndrome”: assessment of sleep quality and disability. Pain Med. 2015 Sep 23; Epub.
    1. Katz JA, Swerdloff MA, Brass SD, Argoff CE, Markman J, Backonja M, Katz N. Opioids for chronic noncancer pain: a position paper of the American Academy of Neurology. Neurology. 2015;84(14):1503–1505.
    1. Manchikanti L. The growth of interventional pain management in the new millennium: a critical analysis of utilization in the Medicare population. Pain Physician. 2004;7(4):465–482.
    1. Bicket MC, Horowitz JM, Benzon HT, Cohen SP. Epidural injections in prevention of surgery for spinal pain: systematic review and meta-analysis of randomized controlled trials. Spine J. 2015;15(2):348–362.
    1. Zencirci B. Analgesic efficacy of oral gabapentin added to standard epidural corticosteroids in patients with failed back surgery. Clin Pharmacol. 2010;2:207–211.
    1. Rahimzadeh P, Sharma V, Imani F, Faiz HR, Ghodraty MR, Nikzad-Jamnani AR, Nader ND. Adjuvant hyaluronidase to epidural steroid improves the quality of analgesia in failed back surgery syndrome: a prospective randomized clinical trial. Pain Physician. 2014;17(1):E75–E82.
    1. Kim SB, Lee KW, Lee JH, Kim MA, An BW. The effect of hyaluronidase in interlaminar lumbar epidural injection for failed back surgery syndrome. Ann Rehabil Med. 2012;36(4):466–473.
    1. Helm Ii S, Racz GB, Gerdesmeyer L, et al. Percutaneous and endoscopic adhesiolysis in managing low back and lower extremity pain: a systematic review and meta-analysis. Pain Physician. 2016;19(2):E245–E281.
    1. Costandi S, Garcia-Jacques M, Dews T, et al. Optimal temperature for radiofrequency ablation of lumbar medial branches for treatment of facet – mediated back pain. Pain Pract. 2015 Sep 15; Epub.
    1. McCormick ZL, Marshall B, Walker J, McCarthy R, Walega DR. Long-Term Function, Pain and Medication Use Outcomes of Radiofrequency Ablation for Lumbar Facet Syndrome. Int J Anesth Anesth. 2015;2(2) pii:028.
    1. Melzack R, Wall PD. Pain mechanisms: a new theory. Survey Anesth. 1967;11(2):89–90.
    1. Shealy CN, Mortimer JT, Reswick JB. Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg. 1967;46(4):489–491.
    1. Guan Y. Spinal cord stimulation: neurophysiological and neurochemical mechanisms of action. Curr Pain Headache Rep. 2012;16(3):217–225.
    1. Kumar K, Taylor RS, Jacques L, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain. 2007;132(1):179–188.
    1. Zucco F, Ciampichini R, Lavano A, et al. Cost-effectiveness and cost-utility analysis of spinal cord stimulation in patients with failed back surgery syndrome: results from the PRECISE study. Neuromodulation. 2015;18(4):266–276.
    1. Rigoard P, Desai MJ, North RB, et al. Spinal cord stimulation for predominant low back pain in failed back surgery syndrome: study protocol for an international multicenter randomized controlled trial (PROMISE study) Trials. 2013;14(1):376.
    1. de Vos CC, Bom MJ, Vanneste S, Lenders MW, de Ridder D. Burst spinal cord stimulation evaluated in patients with failed back surgery syndrome and painful diabetic neuropathy. Neuromodulation. 2014;17(2):152–159.
    1. Schu S, Slotty PJ, Bara G, von Knop M, Edgar D, Vesper J. A prospective, randomised, double-blind, placebo-controlled study to examine the effectiveness of burst spinal cord stimulation patterns for the treatment of failed back surgery syndrome. Neuromodulation. 2014;17(5):443–450.
    1. Lad SP, Babu R, Bagley JH, et al. Utilization of spinal cord stimulation in patients with failed back surgery syndrome. Spine. 2014;39(12):E719–E727.
    1. Waddell G, Kummel EG, Lotto WN, Graham JD, Hall H, McCulloch JA. Failed lumbar disc surgery and repeat surgery following industrial injuries. J Bone Joint Surg Am. 1979;61(2):201–207.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere