Treatment Outcomes for Patients with Failed Back Surgery

Area of Science:

• Neurosurgery
• Pain Management
• Evidence-Based Medicine

Background:

• Failed back surgery syndrome (FBSS) is a common complication after lumbar spinal surgery.
• The exact pathophysiology of FBSS remains unclear despite various investigations.
• Multiple treatment options exist, but their clinical outcomes are not well-defined.

Purpose of the Study:

• To systematically evaluate the outcomes of different treatment modalities for FBSS.
• To establish evidence-based treatment guidelines for patients suffering from FBSS.

Main Methods:

• A systematic review of English-language literature from 1980 to February 2016 was conducted.
• Searches were performed in PubMed, EMBASE, and Cochrane Library for FBSS treatments.
• Quality assessment and evidence levels were determined using the SIGN Methodology Checklist.

Main Results:

• Twenty-three articles were reviewed, analyzing treatments for refractory back or radiating pain.
• Epidural adhesiolysis demonstrated short-term efficacy (Grade A), and spinal cord stimulation showed mid-term effectiveness (Grade B).
• Epidural injections offered short-term pain relief (Grade C), while other treatments had limited or inconclusive evidence (Grade D).

Conclusions:

• Epidural adhesiolysis and spinal cord stimulation are recommended for managing chronic pain in FBSS.
• These interventions show significant effectiveness, with recommendation grades A and B, respectively.
• Other treatment modalities for FBSS exhibit poor or inconclusive evidence, highlighting the need for further investigation.