Synonyms: failed back syndrome (FBS), failed postlaminectomy syndrome
Criteria:
(1) The patient has chronic back pain.
(2) The patient undergoes back surgery for the pain.
(3) Pain and disability persists after surgery (this may be the same as before surgery or different).
Possible explanations:
(1) The surgeon failed to or was unable to repair the defect causing the pain.
(2) There was more than one cause for the back pain, and not all were corrected by surgery.
(3) Scarring after surgery introduced another reason for pain.
(4) The pain is associated with psychosocial issues and/or malingering.
Some conditions that may contribute to persistent pain:
(1) spinal stenosis
(2) recurrent disc herniation
(3) nerve entrapment in fibrous tissue
(4) nerve injury
(5) neuropathy
(6) vascular disease
(7) vertebral instability
(8) degenerative arthritis, including the sacroiliac joint
(9) chronic inflammation
Recommendations:
(1) Back surgery should be performed only if it is indicated with clearly defined goals.
(2) The best surgeon available should perform the procedure.
(3) A patient undergoing back surgery needs to be carefully selected.
(4) The possibility of pain persisting after surgery needs to be incorporated into the informed consent.
(5) Some patients may benefit from a second procedure but these patients need to be carefully selected.
(6) A patient with persistent back pain often requires multidisciplinary care
