Abstract
Over the years, a number of diagnostic and treatment methods for persistent low back pain following spine surgery, the failed back surgery syndrome (FBSS), have been developed. Some authors recognise persistent pain after back surgery as a syndrome in its own right, without regard to the mechanism or cause of pain.
FBSS has important medical, social, legal and economic implications on the whole society as well as on every involved patient and his (her) environment. We should keep in mind the complexity of this clinical problem, the multidimensional nature of chronic pain (mechanistic and pathologic heterogeneity), psychological and social comorbidities, variation in pain experience of the patient population with FBSS.
The general lack of studies with a high-quality design results in differences in outcome assessment and failed efforts to optimize patient selection to operation (reoperation), diagnostic and treatment criteria, and have resulted in a wide variation of reported outcomes. Recent work has focused on the necessity of refining the therapies for FBSS and identification of factors influencing therapeutic outcome and improving patient selection criteria.
Failure of surgical treatment and errors in diagnostic procedures may depend on preoperative, perioperative, or postoperative factors. The causes of FBSS vary widely and include many factors.
It is very difficult to treat complaints related to this syndrome due to a variability of pain generators. Selection of optimal treatment modalities is difficult because the cause of pain and origin of this syndrome have not been precisely defined in a lot of individual cases.
At present, it appears a large proportion of patients have identifiable and potentially treatable lesions. That is why FBSS is not a nihilistic endpoint yet and almost all FBSS are potentialy curable