Wasser Pain Management Center, Mount Sinai Hospital, Toronto, Ontario, Canada.
Pain Med. 2011 Apr;12(4):577-606. doi: 10.1111/j.1526-4637.2011.01089.x. Epub 2011 Apr 4.
Failed back surgery syndrome (FBSS) is a chronic pain condition that has considerable impact on the patient and health care system. Despite advances in surgical technology, the rates of failed back surgery have not declined. The factors contributing to the development of this entity may occur in the preoperative, intraoperative, and postoperative periods. Due to the severe pain and disability this syndrome may cause, more radical treatments have been utilized. Recent trials have been published that evaluate the efficacy and cost-effectiveness of therapeutic modalities such as spinal cord stimulation for the management of patients with failed back surgery.
This article will describe the epidemiology and etiology of FBSS. The importance of prevention will be emphasized. In those patients with established FBSS, a guide to interdisciplinary evaluation and management will be outlined. Special attention will focus on recent trials that have studied the efficacy of more invasive procedures such as spinal cord stimulation. Finally, a suggested management pathway is presented.
FBSS is a challenging clinical entity with significant impact on the individual and society. To better prevent and manage this condition, knowledge of the factors contributing to its development is necessary. While research on FBSS has increased in recent years, perhaps the best strategy to reduce incidence and morbidity is to focus on prevention. Patients diagnosed with FBSS should be managed in an interdisciplinary environment. More radical treatments for FBSS have now been extensively studied providing clinicians with much needed evidence on their efficacy. Incorporating these results into our current knowledge provides a basis on which to construct an evidence-based guide on how best to manage patients who suffer from FBSS.
失败的腰椎手术综合征（FBSS）是一种慢性疼痛疾病，对患者和医疗保健系统都有重大影响。尽管手术技术有所进步，但腰椎手术失败的比率并没有下降。导致这种情况发生的因素可能发生在手术前、手术中和手术后。由于这种综合征可能导致严重的疼痛和残疾，因此已经采用了更激进的治疗方法。最近已经发表了一些试验，评估了脊髓刺激等治疗方式在治疗腰椎手术失败患者中的疗效和成本效益。
本文将描述 FBSS 的流行病学和病因。将强调预防的重要性。对于已确诊的 FBSS 患者，将概述跨学科评估和管理的指南。特别关注最近研究了脊髓刺激等更具侵袭性手术疗效的试验。最后，提出了一种管理途径。
FBSS 是一种具有挑战性的临床实体，对个人和社会都有重大影响。为了更好地预防和管理这种情况，必须了解导致其发展的因素。尽管近年来对 FBSS 的研究有所增加，但也许减少发病率和发病率的最佳策略是专注于预防。诊断为 FBSS 的患者应在跨学科环境中进行管理。现在已经对 FBSS 的更激进治疗方法进行了广泛研究，为临床医生提供了关于其疗效的急需证据。将这些结果纳入我们现有的知识基础，为构建如何最好地管理患有 FBSS 的患者的循证指南提供了依据。
