Neurostimulation for the Management of Failed Back Surgery Syndrome (FBSS)

Abstract

The term failed back surgery syndrome (FBSS) is commonly used to describe patients who have ongoing chronic pain after surgery of the lumbar spine. Patients present with persisting spinal (low back or cervical) pain that may or may not radiate into the limb. This denomination is not correct. It feeds the impression as if spine surgery has not been carried out properly. After spine surgery, approximately 30 % of patients continue to have disabling postoperative persistent or recurrent back pain, with or without leg pain. This may be due to a lot of factors, but mainly due to improper surgery or to the FBSS. The correct description of FBSS has been postulated by Kumar et al. in 1998: “persistent or recurrent back and leg pain after lumbar spinal surgery where no indication of macroscopic pathology justifying re-operation can be demonstrate”. As such FBSS is not the same as unsuccessful surgery. The reasons for unsuccessful surgery are mostly a lack of correct diagnosis, incorrect surgical technique, and an important psychosocial distress of the patient (see also Chap. 23). FBSS can only be the result of spine surgery based on a proper diagnosis, executed correctly in a psychologically non-disturbed patient. Although in case of FBSS patients, the exact cause of the pain is commonly unknown, its nature is usually that of a neuropathic pain, often with peripheral and/or central sensitization (see also Chap. 22). The pain can be in the lower back (or cervical region) but is predominantly in the extremities. It is believed that the cause of FBSS is an intrinsic radiculopathy (peripheral sensitization) of a properly decompressed nerve root. Neuropathic low back pain is probably mainly the result of new but pathologic innervation of the disc, which runs concomitant with its (neo)vascularization upon degeneration or post-discectomy.