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Etiologies of failed back surgery syndrome
Curtis W Slipman1, Carl H Shin, Rajeev K Patel
1Penn Spine Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA. slipman@mail.med.upenn.edu
Pain Medicine (Malden, Mass.)
|April 22, 2004
Summary
Failed back surgery syndrome (FBSS) involves numerous causes, with roughly half stemming from surgical issues. This study found that most patients with FBSS can receive a specific diagnosis after a thorough workup.
Area of Science:
- Spine surgery outcomes
- Epidemiology of chronic pain
- Diagnostic criteria for back pain
Background:
- Failed back surgery syndrome (FBSS) is an imprecise term for persistent pain after lumbar surgery.
- Existing literature focuses on surgical causes, neglecting nonsurgical perspectives.
- A comprehensive understanding of FBSS etiologies is lacking.
Purpose of the Study:
- To investigate the epidemiologic data of both nonsurgical and surgical causes of FBSS.
- To provide a nonsurgical perspective on the differential diagnoses of FBSS.
- To identify common etiologies contributing to FBSS.
Main Methods:
- Retrospective chart review of patients with post-lumbar surgery pain.
- Development of inclusion/exclusion criteria for 42 differential diagnoses.
- Data extraction using keywords: discectomy, laminectomy, fusion.
Main Results:
- Reviewed 267 charts; 197 had complete workups, with 186 known diagnoses.
- Identified 23 distinct diagnoses, with a near equal split between nonsurgical (44.4%) and surgical (55.6%) causes.
- Most common diagnoses: spinal stenosis, internal disc disruption, recurrent disc, neural fibrosis.
Conclusions:
- FBSS encompasses a wide range of surgical and nonsurgical etiologies.
- Approximately 50% of FBSS cases have a surgical origin.
- A specific diagnosis can be established for about 95% of FBSS patients.