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failed_back_surgery_syndrome

Failed back surgery syndrome

(also called FBSS, or failed back syndrome) is a misnomer, as it is not actually a syndrome - it is a very generalized term that is often used to describe the condition of patients who have not had a successful result with spine surgery and have experienced continued pain after surgery. There is no equivalent term for failed back surgery syndrome in any other type of surgery (e.g. there is no failed cardiac surgery syndrome, failed knee surgery syndrome, etc.).

Chronic neuropathic pain has been recognized as contributing to a significant proportion of chronic pain globally. Among these, spinal pain is of significance with failed back surgery syndrome (FBSS), generating considerable expense for the health care systems with increasing prevalence and health impact.

Epidemiology

Following lumbosacral spine surgery, between 5 and 50% of patients suffer from failed back surgery syndrome 1) 2).

Etiology

Dural fibrosis and epidural adhesion after laminectomy are developed from adjacent dense scar tissue, which is a natural wound healing process 3) 4) 5) 6). , and ranked as the major contributor for postoperative pain recurrence after laminectomy or discectomy, and has been implicated as an important cause of failed back surgery syndrome.

Lumbar disc herniation

The surgery for herniated disc is the most common operation at the level of the lumbar spine. The failed surgery rates range between 10% and 40%, conforming what is known as Failed Back Surgery Syndrome (FBSS). Return to work after surgery occurs in 70-85% of the cases.

One out of three patients operated of herniated lumbar disc in our area presented failed disc surgery and the return to work occurred in 2 out of three patients active before the operation. The failed surgery patient suffers from pain, that interferes and limits the labour and home activities. Furthermore, the patient presents frequent sensation of fatigue and exhaustion and also emotional problems that contribute to interfere with work and activities of the daily life 7).

There are many reasons that a back surgery may or may not work, and even with the best surgeon and for the best indications, spine surgery is no more than 95% predictive of a successful result.

Reasons for Failed Back Surgery and Pain after Surgery Spine surgery is basically able to accomplish only two things:

Decompress a nerve root that is pinched, or Stabilize a painful joint. Unfortunately, back surgery or spine surgery cannot literally cut out a patient’s pain. It is only able to change anatomy, and an anatomical lesion (injury) that is a probable cause of back pain must be identified prior to rather than after back surgery or spine surgery.

Differential diagnosis

The preoperative identification of lumbar foraminal stenosis (LSFS) is important because a lack of recognition of this clinical entity is often associated with failed back surgery syndrome. Although magnetic resonance imaging (MRI) is widely used, and is considered by many as an appropriate tool for studying spine pathologies, there is limited data to suggest that MRI examinations are sufficiently sensitive or specific for the diagnosis of LSFS 8).

Treatment

There is significant (Level I to II) evidence of the efficacy of spinal cord stimulation in lumbar FBSS; whereas, there is moderate (Level II to III) evidence for high frequency stimulation; there is limited evidence for adaptive stimulation and burst stimulation.

Innovation in spinal cord stimulation therapy has intensified with numerous new technical capabilities, safety advances, and novel stimulation targets. This progress holds hope for the many sufferers of chronic pain 9).

1)
Macrae WA: Chronic pain after surgery.Br J Anaesth 2001, 87:88-98.
2)
Taylor RS, Taylor RJ: The economics of failed back surgery syndrome. Br J Pain 2012, 6:140-141
3)
Alkalay RN, Kim DH, Urry DW, Xu J, Parker TM, Glazer PA. Prevention of postlaminectomy epidural fibrosis using bioelastic materials. Spine (Phila Pa 1976) 2003;28:1659–1665.
4)
Hsu CJ, Chou WY, Teng HP, Chang WN, Chou YJ. Coralline hydroxyapatite and laminectomy-derived bone as adjuvant graft material for lumbar posterolateral fusion. J Neurosurg Spine. 2005;3:271–275.
5)
Temel SG, Ozturk C, Temiz A, Ersozlu S, Aydinli U. A new material for prevention of epidural fibrosis after laminectomy: oxidized regenerated cellulose (interceed), an absorbable barrier. J Spinal Disord Tech. 2006;19:270–275.
6)
Yu CH, Lee JH, Baek HR, Nam H. The effectiveness of poloxamer 407-based new anti-adhesive material in a laminectomy model in rats. Eur Spine J. 2012;21:971–979.
7)
Rodríguez-García J, Sánchez-Gastaldo A, Ibáñez-Campos T, Vázquez-Sousa C, Cantador-Hornero M, Expósito-Tirado JA, Cayuela-Domínguez A, Echevarría-Ruiz de Vargas C. [Related factors with the failed surgery of herniated lumbar disc]. Neurocirugia (Astur). 2005 Dec;16(6):507-17. Spanish. PubMed PMID: 16378133.
8)
Ohba T, Ebata S, Fujita K, Sato H, Devin CJ, Haro H. Characterization of symptomatic lumbar foraminal stenosis by conventional imaging. Eur Spine J. 2015 Oct;24(10):2269-75. doi: 10.1007/s00586-015-3859-4. PubMed PMID: 25772088.
9)
Kumar K, Caraway DL, Rizvi S, Bishop S. Current challenges in spinal cord stimulation. Neuromodulation. 2014 Jun;17 Suppl 1:22-35. doi: 10.1111/ner.12172. PubMed PMID: 24974773.
failed_back_surgery_syndrome.txt · Last modified: 2019/08/14 12:09 by administrador