• Mohammed F Shamji and Alina Shcharinsky.
• Neurosurgery. 2015 Aug 1;62 Suppl 1:227.

IntroductionFailed back surgery syndrome (FBSS) is a type of neuropathic pain where extremity symptoms persist despite structurally corrective spinal surgery. This implies more substantial nerve damage rather than simply dysfunction whereby correcting the inciting structural derangement does not provide for clinical resolution. What remains unclear is how to predict which patients are likely to derive benefit from surgical intervention, and whether specific pain characteristics are associated with different likelihoods of good outcome.MethodsThis study analyzed a prospective data set of patients managed surgically for painful radiculopathy secondary to lumbar degenerative spondylosis by the senior author at Toronto Western Hospital neurosurgery over the past 24 months. Clinical parameters include general demographics, preoperative and postoperative clinical examination, surgical details, general self-reported pain and disability scores, and neuropathic pain scores. The screening tests used in this study were Douleur Neuropathique 4 (DN4) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), correlation tested by the Spearman coefficient. Multiple logistic regression analysis was used to define predictors of persistent postoperative symptomatology.ResultsAmong 250 patients treated for lumbar radiculopathy, 12% exhibited FBSS with modest relief of leg pain compared with the cohort of patients in whom substantial improvement was seen. The postoperative condition was associated with abnormal preoperative screens for neuropathic pain, but not sex, smoking status, or preoperative pain severity. Good correlation was seen between the 2 screening tests used in this study for both absolute ordinal score and thresholding as neuropathic pain (Spearman, P < .001).ConclusionWhile FBSS was more common among younger and female patients, this occurred with low overall frequency. Higher neuropathic pain screening scores correlated strongly with the likelihood and severity of significant postoperative leg pain. Further work is required to develop more accurate prognostication tools for patients undergoing structural spinal surgery for lumbar radiculopathy.

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