Van Buyten Jean-Pierre
AZ Maria Middelares Pain Clinic, Sint Niklaas, Belgium.
J Pain Symptom Manage. 2006 Apr;31(4 Suppl):S25-9. doi: 10.1016/j.jpainsymman.2005.12.012.
Failed back surgery syndrome (FBSS) is defined as persistent or recurrent pain, mainly in the lower back and/or legs, even after previous anatomically successful spinal surgery. Treatment of such patients is difficult, with conservative therapy and repeated back surgery often proving unsuccessful at providing adequate pain relief. Spinal cord stimulation (SCS) is a minimally invasive procedure that allows physicians and patients to inexpensively evaluate the response to therapy before permanent implantation. Both trial stimulation and permanent implantation are fully reversible. Early treatment with SCS has been shown to be very effective in well-selected FBSS patients and should be considered instead of reoperation. Clinical studies have demonstrated that SCS provides a sustained, long-term, 50% or more reduction in pain in over 60% of patients and allows concomitant pain medication to be reduced. The substantial improvements in quality of life and functional status permit many patients to return to work. Patients express great satisfaction with SCS and minimal side effects are observed. Moreover, SCS has been shown to be a cost-effective alternative to conventional therapies. Thus, SCS is the treatment of choice in medically refractory FBSS patients where recurrent neuropathic pain persists after surgery and analgesics are no longer effective or accompanied by intolerable side effects.
腰椎手术失败综合征（FBSS）的定义为，即便先前的脊柱手术在解剖学上取得成功，仍存在持续或复发的疼痛，主要位于下背部和/或腿部。此类患者的治疗颇具难度，保守治疗和反复的背部手术往往无法充分缓解疼痛。脊髓刺激（SCS）是一种微创手术，可让医生和患者在永久植入前以低成本评估治疗反应。试验性刺激和永久植入均可完全逆转。对于精心挑选的FBSS患者，早期采用SCS治疗已被证明非常有效，应考虑采用SCS而非再次手术。临床研究表明，超过60%的患者使用SCS后疼痛持续减轻50%或更多，且能减少伴随使用的止痛药物。生活质量和功能状态的显著改善使许多患者能够重返工作岗位。患者对SCS表示高度满意，且观察到的副作用极小。此外，SCS已被证明是一种比传统疗法更具成本效益的选择。因此，对于药物治疗无效的FBSS患者，若术后复发性神经病理性疼痛持续存在，且镇痛药不再有效或伴有无法耐受的副作用，SCS是首选治疗方法。
