Treatment outcomes for patients with failed back surgery

Jae Hwan Cho, Jae Hyup Lee, Kwang Sup Song, Jae Young Hong, Yoon Suk Joo, Dong Ho Lee, Chang Ju Hwang, Choon Sung Lee

Research output: Contribution to journalReview articleResearchpeer-review

12 Citations (Scopus)

Abstract

Background: Failed back surgery syndrome (FBSS) is a frequently encountered disease entity following lumbar spinal surgery. Although many plausible reasons have been investigated, the exact pathophysiology remains unknown. Various medications, reoperations, interventions such as spinal cord stimulation, epidural adhesiolysis or epidural injection, exercise therapy, and psychotherapy have been suggested treatment options. However, the evidence of the clinical outcome for each treatment has not been clearly determined. Objectives: To evaluate the outcomes of each treatment modality and to present treatment guidelines for patients with FBSS. Study Design: A systematic review of each treatment regimen in patients with FBSS. Methods: The available literature regarding each modality for the treatment of refractory back pain or radiating pain for FBSS was reviewed. The quality assessment and the level of evidence were analyzed using the “Methodology Checklist” of SIGN (Scottish Intercollegiate Guidelines Network). Data sources included relevant English language literature identified through searches of Pubmed, EMBASE, and Cochrane library from 1980 to Feb 2016. The primary outcome measure was pain relief of back pain or radiating pain for at least 3 months. Secondary outcome measures were improvement of the patient’s functional status, health-related quality of life, return to work, and reduction of opioid use. Results: Twenty-three articles were finally identified and reviewed. Based on our analysis, epidural adhesiolysis showed a short-term (6 to 24 months) effect (grade A) and spinal cord stimulation showed a mid-term (2 or 3 years) effect (grade B). Epidural injections showed a short-term (up to 2 years) effect (grade C). However, other treatments were recommended as grade D or inconclusive. Limitations: The limitations of this systematic review included the rarity of relevant literature. Conclusions: Epidural adhesiolysis or spinal cord stimulation can be effective in order to control chronic back pain or leg pain due to FBSS, and its recommendation grades are A and B, respectively. Other treatments showed poor or inconclusive evidence.

Original languageEnglish
Pages (from-to)E29-E43
JournalPain Physician
Volume20
Issue number1
StatePublished - 1 Jan 2017

Fingerprint

Failed Back Surgery Syndrome
Spinal Cord Stimulation
Back Pain
Epidural Injections
Pain
Therapeutics
Outcome Assessment (Health Care)
Guidelines
Exercise Therapy
Intractable Pain
Return to Work
Information Storage and Retrieval
Checklist
Reoperation
PubMed
Psychotherapy
Chronic Pain
Opioid Analgesics
Libraries
Leg

Keywords

  • Chronic low back pain
  • Epidural adhesiolysis
  • Epidural injection
  • Failed back surgery syndrome
  • Post lumbar surgery syndrome
  • Post spinal surgery syndrome
  • Revision
  • Spinal cord stimulation

Cite this

Cho, J. H., Lee, J. H., Song, K. S., Hong, J. Y., Joo, Y. S., Lee, D. H., ... Lee, C. S. (2017). Treatment outcomes for patients with failed back surgery. Pain Physician, 20(1), E29-E43.
Cho, Jae Hwan ; Lee, Jae Hyup ; Song, Kwang Sup ; Hong, Jae Young ; Joo, Yoon Suk ; Lee, Dong Ho ; Hwang, Chang Ju ; Lee, Choon Sung. / Treatment outcomes for patients with failed back surgery. In: Pain Physician. 2017 ; Vol. 20, No. 1. pp. E29-E43.
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title = "Treatment outcomes for patients with failed back surgery",
abstract = "Background: Failed back surgery syndrome (FBSS) is a frequently encountered disease entity following lumbar spinal surgery. Although many plausible reasons have been investigated, the exact pathophysiology remains unknown. Various medications, reoperations, interventions such as spinal cord stimulation, epidural adhesiolysis or epidural injection, exercise therapy, and psychotherapy have been suggested treatment options. However, the evidence of the clinical outcome for each treatment has not been clearly determined. Objectives: To evaluate the outcomes of each treatment modality and to present treatment guidelines for patients with FBSS. Study Design: A systematic review of each treatment regimen in patients with FBSS. Methods: The available literature regarding each modality for the treatment of refractory back pain or radiating pain for FBSS was reviewed. The quality assessment and the level of evidence were analyzed using the “Methodology Checklist” of SIGN (Scottish Intercollegiate Guidelines Network). Data sources included relevant English language literature identified through searches of Pubmed, EMBASE, and Cochrane library from 1980 to Feb 2016. The primary outcome measure was pain relief of back pain or radiating pain for at least 3 months. Secondary outcome measures were improvement of the patient’s functional status, health-related quality of life, return to work, and reduction of opioid use. Results: Twenty-three articles were finally identified and reviewed. Based on our analysis, epidural adhesiolysis showed a short-term (6 to 24 months) effect (grade A) and spinal cord stimulation showed a mid-term (2 or 3 years) effect (grade B). Epidural injections showed a short-term (up to 2 years) effect (grade C). However, other treatments were recommended as grade D or inconclusive. Limitations: The limitations of this systematic review included the rarity of relevant literature. Conclusions: Epidural adhesiolysis or spinal cord stimulation can be effective in order to control chronic back pain or leg pain due to FBSS, and its recommendation grades are A and B, respectively. Other treatments showed poor or inconclusive evidence.",
keywords = "Chronic low back pain, Epidural adhesiolysis, Epidural injection, Failed back surgery syndrome, Post lumbar surgery syndrome, Post spinal surgery syndrome, Revision, Spinal cord stimulation",
author = "Cho, {Jae Hwan} and Lee, {Jae Hyup} and Song, {Kwang Sup} and Hong, {Jae Young} and Joo, {Yoon Suk} and Lee, {Dong Ho} and Hwang, {Chang Ju} and Lee, {Choon Sung}",
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Cho, JH, Lee, JH, Song, KS, Hong, JY, Joo, YS, Lee, DH, Hwang, CJ & Lee, CS 2017, 'Treatment outcomes for patients with failed back surgery', Pain Physician, vol. 20, no. 1, pp. E29-E43.

Treatment outcomes for patients with failed back surgery. / Cho, Jae Hwan; Lee, Jae Hyup; Song, Kwang Sup; Hong, Jae Young; Joo, Yoon Suk; Lee, Dong Ho; Hwang, Chang Ju; Lee, Choon Sung.

In: Pain Physician, Vol. 20, No. 1, 01.01.2017, p. E29-E43.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Treatment outcomes for patients with failed back surgery

AU - Cho, Jae Hwan

AU - Lee, Jae Hyup

AU - Song, Kwang Sup

AU - Hong, Jae Young

AU - Joo, Yoon Suk

AU - Lee, Dong Ho

AU - Hwang, Chang Ju

AU - Lee, Choon Sung

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background: Failed back surgery syndrome (FBSS) is a frequently encountered disease entity following lumbar spinal surgery. Although many plausible reasons have been investigated, the exact pathophysiology remains unknown. Various medications, reoperations, interventions such as spinal cord stimulation, epidural adhesiolysis or epidural injection, exercise therapy, and psychotherapy have been suggested treatment options. However, the evidence of the clinical outcome for each treatment has not been clearly determined. Objectives: To evaluate the outcomes of each treatment modality and to present treatment guidelines for patients with FBSS. Study Design: A systematic review of each treatment regimen in patients with FBSS. Methods: The available literature regarding each modality for the treatment of refractory back pain or radiating pain for FBSS was reviewed. The quality assessment and the level of evidence were analyzed using the “Methodology Checklist” of SIGN (Scottish Intercollegiate Guidelines Network). Data sources included relevant English language literature identified through searches of Pubmed, EMBASE, and Cochrane library from 1980 to Feb 2016. The primary outcome measure was pain relief of back pain or radiating pain for at least 3 months. Secondary outcome measures were improvement of the patient’s functional status, health-related quality of life, return to work, and reduction of opioid use. Results: Twenty-three articles were finally identified and reviewed. Based on our analysis, epidural adhesiolysis showed a short-term (6 to 24 months) effect (grade A) and spinal cord stimulation showed a mid-term (2 or 3 years) effect (grade B). Epidural injections showed a short-term (up to 2 years) effect (grade C). However, other treatments were recommended as grade D or inconclusive. Limitations: The limitations of this systematic review included the rarity of relevant literature. Conclusions: Epidural adhesiolysis or spinal cord stimulation can be effective in order to control chronic back pain or leg pain due to FBSS, and its recommendation grades are A and B, respectively. Other treatments showed poor or inconclusive evidence.

AB - Background: Failed back surgery syndrome (FBSS) is a frequently encountered disease entity following lumbar spinal surgery. Although many plausible reasons have been investigated, the exact pathophysiology remains unknown. Various medications, reoperations, interventions such as spinal cord stimulation, epidural adhesiolysis or epidural injection, exercise therapy, and psychotherapy have been suggested treatment options. However, the evidence of the clinical outcome for each treatment has not been clearly determined. Objectives: To evaluate the outcomes of each treatment modality and to present treatment guidelines for patients with FBSS. Study Design: A systematic review of each treatment regimen in patients with FBSS. Methods: The available literature regarding each modality for the treatment of refractory back pain or radiating pain for FBSS was reviewed. The quality assessment and the level of evidence were analyzed using the “Methodology Checklist” of SIGN (Scottish Intercollegiate Guidelines Network). Data sources included relevant English language literature identified through searches of Pubmed, EMBASE, and Cochrane library from 1980 to Feb 2016. The primary outcome measure was pain relief of back pain or radiating pain for at least 3 months. Secondary outcome measures were improvement of the patient’s functional status, health-related quality of life, return to work, and reduction of opioid use. Results: Twenty-three articles were finally identified and reviewed. Based on our analysis, epidural adhesiolysis showed a short-term (6 to 24 months) effect (grade A) and spinal cord stimulation showed a mid-term (2 or 3 years) effect (grade B). Epidural injections showed a short-term (up to 2 years) effect (grade C). However, other treatments were recommended as grade D or inconclusive. Limitations: The limitations of this systematic review included the rarity of relevant literature. Conclusions: Epidural adhesiolysis or spinal cord stimulation can be effective in order to control chronic back pain or leg pain due to FBSS, and its recommendation grades are A and B, respectively. Other treatments showed poor or inconclusive evidence.

KW - Chronic low back pain

KW - Epidural adhesiolysis

KW - Epidural injection

KW - Failed back surgery syndrome

KW - Post lumbar surgery syndrome

KW - Post spinal surgery syndrome

KW - Revision

KW - Spinal cord stimulation

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M3 - Review article

VL - 20

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JO - Pain Physician

JF - Pain Physician

SN - 1533-3159

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Cho JH, Lee JH, Song KS, Hong JY, Joo YS, Lee DH et al. Treatment outcomes for patients with failed back surgery. Pain Physician. 2017 Jan 1;20(1):E29-E43.