• British journal of pain · Nov 2012

    Failed back surgery syndrome: a suggested algorithm of care.

    • Praveen Ganty and Manohar Sharma.
    • The Walton Centre for Neurology & Neurosurgery NHS Foundation Trust, Liverpool, UK.
    • Br J Pain. 2012 Nov 1;6(4):153-61.

    AbstractFailed back surgery syndrome (FBSS) is a complex condition which can be very difficult to treat. In this article, we propose a pragmatic algorithm for the management of the syndrome. The management of this condition should include a comprehensive initial assessment to rule out treatable cause, pharmacological optimisation, psychological techniques and neuromodulation. There is good evidence to support early application of conventional spinal cord stimulation for FBSS patients suffering from predominant buttock and leg pain. Emerging techniques in neuromodulation such as high-frequency spinal cord stimulation, peripheral nerve field stimulation and dorsal root ganglion stimulation hold promise for the future, but long-term outcome regarding efficacy and safety is not yet established. Intrathecal drug delivery systems should also be considered in those who are unsuitable or unresponsive to neuromodulation and still warrant further treatment. However, the long-term outcome may not be as good as with other treatments mentioned above.

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