Failed Back Surgery Syndrome

Persistent or recurrent chronic pain after one or more surgical procedures on the lumbo-sacral spine."

It is described if pain persists or occurs for 8-12 weeks

Prevalence is 10-40% of lumbar spine operations.

Patient presents with backpain and severe depression.

Pain is both nocieceptive and neuropathic type.

Aetiology

Surgical cause

• Post operative epidural fibrosis or arachnoiditis.
• Instability due to laminectomy
• Nerve injury causing neuropathic pain
• Infection

Perioperative surgical cause

• Injury to cord or nerve root
• Hematoma formation
• Failure of fusion
• Extensive fusion or instumentation

Non Surgical cause

• Unrecognised local recess stenosis or lateral disc herniation (Commonest cause)
• Recurrent disc herniation
• Operation at wrong intervertebral space

Treatment modalities

Assurance and rehabilitation of the patients
Pharmacotherapy
Percutaneous fluroscopic Procedures
Epidural adhesionolysis through transforaminal or caudal route
Ozone Discectomy

Advance procedures
R.F. denervation of facet joints
Spinal cord stimulation