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Failed back surgery: etiology and diagnostic evaluation.

Jerome Schofferman1, James Reynolds, Richard Herzog

  • 1San Francisco Spine Institute-SpineCare Medical Group, 1850 Sullivan Avenue, Daly City, CA 94014, USA. jschoff@ix.netcom.com

The Spine Journal : Official Journal of the North American Spine Society
|November 1, 2003
PubMed
Summary
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Accurate diagnosis of failed back surgery syndrome (FBSS) is crucial for effective treatment. A comprehensive approach including history, imaging, psychological evaluation, and diagnostic injections achieves over 90% diagnostic accuracy for FBSS.

Area of Science:

  • Spine surgery
  • Pain management
  • Diagnostic imaging

Background:

  • Synopsis of a 2002 North American Spine Society Annual Meeting symposium.
  • Focuses on the diagnosis of failed back surgery syndrome (FBSS).

Framework:

  • Emphasizes precise diagnosis as key to successful FBSS treatment.
  • Utilizes a multi-faceted diagnostic approach.

Implementation:

  • Combines patient history, physical examination, imaging studies, psychological evaluation, and diagnostic injections.
  • Achieves diagnostic accuracy in over 90% of FBSS cases.
  • Identifies common causes: foraminal stenosis, painful disc, pseudarthrosis, neuropathic pain, recurrent disc herniation, facet joint pain, and sacroiliac joint pain.

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Implications:

  • Highlights the importance of recognizing psychological factors in FBSS.
  • Diagnostic injections are valuable for specific pain sources (facet, SIJ, discogenic).
  • Spine surgeons need awareness of common FBSS causes for thorough patient evaluation and problem minimization.