21 - Failed back surgery syndrome

Abstract

Failed back surgery syndrome refers to lumbar pain with or without radicular symptoms that persists or appears after one or several surgical interventions. Historically, the term has been controversial and is not necessarily the consequence of a failed surgical procedure. Regardless, this condition is associated with several comorbidities and a high incidence of physical and psychological dysfunction. Moreover, failed back surgery syndrome is not uncommon, with incidences ranging between 10% and 40% and thus represents an important health problem. This, combined with the continuous increase in number of lumbar surgeries, represents a tremendous economic cost, especially when mistreated. The exact pathophysiology remains unclear in most of the cases as contributing factors may be numerous and varied. Anatomical variations, psychological status of the patients, technical or hardware nuances, and even socioeconomic issues may be involved. Diagnosis is difficult and must include a careful matching of the clinical presentation with the suspected anatomical anomaly, as well as a psychosocial assessment that includes behavioral elements such as anxiety disorder and secondary gain. A multidisciplinary medical approach is mandatory. Unless irrefutable indications for surgery are documented, conservative management should be offered to the patient as the initial treatment.