Ragab Ashraf, Deshazo Richard D
Department of Orthopedics, University of Mississippi Medical Center, Jackson, MS 39216, USA.
Am J Med. 2008 Apr;121(4):272-8. doi: 10.1016/j.amjmed.2008.01.004.
The 80,000 or so patients a year who continue to have chronic, disabling back pain after one or more spinal surgeries are said to have failed back surgery syndrome. There are no controlled studies to guide physicians in the management of these patients. Six anatomical abnormalities of the spine most commonly result in back surgery, and 7 undesirable outcomes lead to failed back surgery syndrome. On the basis of 5 large retrospective studies and our clinical experience, we suggest a systematic approach to these patients. This approach is focused on determination of the specific anatomical abnormality responsible for ongoing symptoms, an abnormality that may or may not be related to the initial abnormality for which surgery was performed. One or more of 5 nonsurgical treatment options may be useful to prevent the need for further surgery, as each subsequent surgery has a lower likelihood of success.
每年约有8万名患者在接受一次或多次脊柱手术后仍患有慢性、致残性背痛，据说他们患有腰椎手术失败综合征。目前尚无对照研究来指导医生对这些患者的治疗。导致脊柱手术最常见的六种解剖学异常，以及七种不良后果会导致腰椎手术失败综合征。基于五项大型回顾性研究和我们的临床经验，我们建议对这些患者采用系统的治疗方法。这种方法侧重于确定导致持续症状的特定解剖学异常，这种异常可能与最初手术治疗的异常有关，也可能无关。五种非手术治疗选择中的一种或多种可能有助于避免进一步手术的需要，因为后续每次手术成功的可能性都较低。
