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Syndrome of unsuccessful operation on the spinal column
Last reviewed: 19.10.2021
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The English-language literature uses the term "failed back surgery syndrome" (FBSS), a syndrome of an unsuccessful operation on the spine, which is defined as prolonged or recurring chronic pain in the lower back and / or in the legs after an anatomically successful spinal surgery.
This term covers a heterogeneous group of causes and residual symptoms after surgical treatment of the pathology of the lumbar spine. The pain that occurs after the surgical decompression of the lumbar and sacral roots is quite frequent. Relapses of back pain after surgical treatment of herniated intervertebral discs of the lumbar spine are noted from 5 to 38% of operated patients. Based on postoperative verifications of the spinal canal, it was suggested that recurrence of the pain syndrome in 36.4% of operated patients is caused by cicatrical-adhesive process in the epidural space, compressing the nerve root and accompanying its radicular artery, and in 28.2% - by a combination of cicatricial and adhesive process with a slight relapse herniated intervertebral disc.
The conducted studies showed that the main causes of FBSS may be foraminous stenosis, internal destruction of the disc, pseudoarthrosis and neuropathic pain, which occur in more than 70% of cases. Pain can be caused by changes in almost all structures of the spine: intervertebral disc, synovial joint, muscles, ligaments, sacroiliac joint. At each of the mechanisms encountered (compression of the nerve root, arthritis, instability, disk degeneration, myositis, fasciitis, bursitis), arachnoiditis and fibrosis in the postoperative patient. With the use of devices for fixing the spine, new causes of pain have appeared.
In many cases of postoperative lumbosciagia, the only cause of its occurrence is the "non-surgical" changes, among which the psychological causes, as well as the so-called "musculoskeletal" changes, are understood as degenerative-dystrophic changes in the spine and surrounding tissues, and pathogenetically related changes in the distant skeletal, articular and musculo-connective structures. At the same time, it is not possible to indicate a single factor among all skeletal-joint and muscle-ligamentous changes in patients with lumbar lumboscialgia, with the exception of individual cases, since, in most cases, a complex of causes seems to matter.
The appearance of lumboschialgia syndrome after decompression of the lumbar and sacral roots can be due to the presence of primary and satellite trigger zones, as well as comorbid disorders (depression and anxiety).
Treatment of patients with FBSS is often very difficult, since neither conservative therapy nor repeated surgical procedures on the spine provide an adequate reduction in pain. FBSS may appear in 30% of patients who have a typical set of problems: sleep disorders, depression, family, economic and social problems. Epidural spinal cord stimulation (SCS) is suggested as the most effective treatment for this group of patients. It is effective when analgesics, in particular opioids, are ineffective when severe side effects occur or a repeated operation on the spine is required.
The algorithm of treatment of patients with FBSS should include: treatment of myogenic trigger zones and allodynia skin areas, trigger zones of postoperative cicatrices, comorbid disorders (depression and anxiety), fitness program.