Post-surgical spine syndrome

Abstract

Dear Sir, It is our view that the diagnostic terms post laminectomy syndrome (ICD-9 code 722.8) or failed back syndrome[1,4,8] are inaccurate, misleading, can be construed as disparaging, and should be discarded. We propose that these terms should be replaced with Post-surgical Spine Syndrome (PSSS). Implicit in the terms is that pain and disability following spinal surgery is the result of failed or unsuccessful surgery. Not infrequently, patients report that following surgery, “my leg pain is gone, but my back still hurts.” A significant number of these patients have facet arthropathy,[2] which was likely present before surgery. As pointed out by Wilkinson,[8] degenerated disk collapses, causes misalignment of the facet joint, which can result in facet pain. Diagnostic facet medial branch injections may help to determine who may benefit from radiofrequency rhizotomy.[5–7] Discectomy may lead to a further collapse of the disk and cause foraminal stenosis and secondary nerve root compression.[6] The other flaw in the terms is the anatomical inaccuracy. There are other varieties of spine surgery than laminectomy. These include discectomy, anterior interbody fusion, posterior interbody fusion, pedicle screw, and other forms of arthrodesis. Furthermore, new techniques are constantly evolving. The proposed term of Post-surgical Spine Syndrome encompasses all forms of spinal surgery. It also covers the pathological conditions that existed prior to surgery, as well as conditions that may be related to the surgery, such as nerve root compression or injury, epidural fibrosis, arachnoiditis, adjacent level degeneration, and spinal instability. If accepted, the new descriptions for the existing ICD-9 codes will be as follows: 722.80 Post-surgical spine syndrome, unspecified region 722.81 Post-surgical spine syndrome, cervical region 722.82 Post-surgical spine syndrome, thoracic region 722.83 Post-surgical spine syndrome, lumbar region When ICD-10 officially replaces ICD-9, the code for all PSSS will be M96.1. The incidence of PSSS may be reduced by a meticulous neurological examination and careful patient selection.[3,7,8] The facet and sacroiliac joints should always be examined, particularly when the pain is predominantly in the lower back, or when it radiates only to the thigh or groin and not below the knee. Patients who have mild or no neurological deficits and whose radiographic or electrophysiological studies show minimal nerve root compression may benefit from a diagnostic selective nerve root injection, before making a surgical decision. Finally, referred visceral pain from the pelvic or abdominal organs should also be excluded by a comprehensive examination. Adherence to these simple guidelines can result in a significant reduction in the pain and suffering, as also the enormous financial cost of PSSS.[3]