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Updated: Mar 31, 2026

Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation
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Failed back surgery syndrome: a suggested algorithm of care.

Praveen Ganty1, Manohar Sharma1

  • 1The Walton Centre for Neurology & Neurosurgery NHS Foundation Trust, Liverpool, UK.

British Journal of Pain
|October 31, 2015
PubMed
Summary

Failed back surgery syndrome (FBSS) management involves assessment, medication, psychological support, and neuromodulation. Conventional spinal cord stimulation is effective for leg pain, while newer techniques show promise but require further study.

Keywords:
Failed back surgery syndromeintrathecal pumpmultidisciplinary teamneuromodulationpain management programmepharmacotherapyspinal cord stimulationtreatment algorithm

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Area of Science:

  • Pain Management
  • Neurosurgery
  • Neurology

Background:

  • Failed back surgery syndrome (FBSS) presents significant treatment challenges.
  • A structured approach is crucial for effective FBSS management.

Purpose of the Study:

  • To propose a pragmatic algorithm for managing Failed back surgery syndrome.
  • To review current and emerging treatment options for FBSS.

Main Methods:

  • Comprehensive initial assessment to identify treatable causes.
  • Pharmacological optimization and psychological interventions.
  • Evaluation of neuromodulation techniques, including spinal cord stimulation, peripheral nerve field stimulation, and dorsal root ganglion stimulation.
  • Consideration of intrathecal drug delivery systems.

Main Results:

  • Conventional spinal cord stimulation shows good evidence for FBSS patients with buttock and leg pain.
  • Emerging neuromodulation techniques offer future potential but lack established long-term efficacy and safety data.
  • Intrathecal drug delivery is an option for non-responders to neuromodulation, though long-term outcomes may be less favorable.

Conclusions:

  • A multi-modal approach including assessment, pharmacotherapy, psychological support, and neuromodulation is recommended for FBSS.
  • Spinal cord stimulation is a viable option for specific FBSS presentations.
  • Further research is needed to establish the long-term outcomes of novel neuromodulation strategies.