Abstract
ABSTRACT Objective: Fail back surgery syndrome (FBSS) is a common cause of pain following spine surgery, and is associated with persistent or recurrent pain despite anatomically correct intervention. Spinal cord stimulation (SCS) is regarded as one of the most effective methods of treatment for fail back surgery syndrome. Methods: We studied 34 patients who underwent test stimulation and chronic SCS for FBSS. Results: Six months postoperatively, mean improvement by the visual analog scale (VAS) of average and maximum daily pain, and the painDETECT score, were 54.4%, 50.7% and 57.3%, respectively. This meets the criteria for effectiveness of the method, according to the literature. Most of patients reported significant improvements in life quality and less need for analgesics. Complications were seen in nine patients (26.4%) and included: intraoperative dura injury (one patient, 2.9%), wound infection (one patient, 2.9%), and electrode displacement (seven patients, 20.5%). No cases of postoperative neurological deterioration were seen. Conclusions: SCS is safe and effective for the treatment of neuropathic pain caused by FBSS. Level of Evidence IV; Case series.
Highlights
Spine surgery is one of the most rapidly developing fields of modern medicine, and more than 1,000,000 spine operations are currently performed each year, worldwide.[1]
Six months postoperatively clear pain relief was demonstrated by all three studied parameters. (Table 1) Complications were seen in nine patients (26.4%) and included: intraoperative dura injury, wound infection, and electrode displacement requiring surgical correction
Spinal cord stimulation (SCS) is an effective method of the treatment for intractable neuropathic pain caused by Fail back surgery syndrome (FBSS)
Summary
Spine surgery is one of the most rapidly developing fields of modern medicine, and more than 1,000,000 spine operations are currently performed each year, worldwide.[1]. The incidence of late postoperative complications is still high.[2] One of the main such complications is fail back surgery syndrome (FBSS, or post-laminectomy syndrome), a term that is still controversial. FBSS can be defined as “Persistent or recurrent pain in the back/neck or limbs, despite surgery or treatment thought likely to relieve pain”,3 “Chronic radicular pain that has recurred or persists in the same distribution despite anatomically satisfactory previous spinal surgery”,4,5 “Lumbar (cervical) pain of unknown origin either persisting despite surgical intervention or appearing after surgical intervention for spinal (origin) pain originally in the same topographical distribution”.6. We can emphasize that FBSS always has the following characteristics: chronic neuropathic pain, history of spine surgery (or surgeries), absence of clear etiologic factor of pain, and anatomically correct primary spine surgery FBSS can be defined as “Persistent or recurrent pain in the back/neck or limbs, despite surgery or treatment thought likely to relieve pain”,3 “Chronic radicular pain that has recurred or persists in the same distribution despite anatomically satisfactory previous spinal surgery”,4,5 “Lumbar (cervical) pain of unknown origin either persisting despite surgical intervention or appearing after surgical intervention for spinal (origin) pain originally in the same topographical distribution”.6 As a result, we can emphasize that FBSS always has the following characteristics: chronic neuropathic pain, history of spine surgery (or surgeries), absence of clear etiologic factor of pain, and anatomically correct primary spine surgery
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