Resident Physician Ohio State University Wexner Medical Center Columbus, Ohio, United States
Introduction: Failed Back Surgery Syndrome (FBSS) is a complex disease process involving failure to achieve satisfactory pain relief following spine surgery. Evaluation and management of FBSS can be nebulous given the vast array of etiologies, and there are few examples of diagnostic/management protocols for FBSS. The purpose of this narrative review is to explore the extant literature regarding the etiology, evaluation, and management of FBSS and to define principles for ideal evaluation to facilitate an optimal algorithmic approach for management.
Methods: A retrospective query of FBSS was performed using the following Mesh terms: “Failed back surgery syndrome, failed back, repeat spine surgery, management, and treatment.” Results were stratified based on relevance to the topic at hand, language, and date of publication. Upon inclusion, papers were evaluated in accordance with the MINORS criteria and were stratified based upon inherent bias.
Results: In the literature, causes of FBSS are diverse, but there are limited examples of diagnostic algorithms for its evaluation and management. Most importantly, the knowledge of etiology has in the past missed evaluation of spinal deformity. While the current few management protocols in existence provide a wide range of options for treatment, their omission of evaluation of coronal or sagittal imbalance means they are limited in scope and risk mismanagement of a segment of the population that would benefit from deformity correction surgery. We propose an evaluation of FBSS using the 3 cardinal tenets of spinal harmony: stenosis, instability, and deformity.
Conclusion : Our principles of spinal harmony guide a tailored algorithm for this spinal pathology that maximizes detection of patients with spinal deformity while offering specified treatment for its different facets. Precision medicine is being touted as the future standard of healthcare around the world, and this precisely targeted algorithm for FBSS will help modernize treatment for this otherwise daunting disease.
