Taylor Rod S, Taylor Rebecca J
Peninsula Medical School, University of Exeter, Exeter, UK.
Br J Pain. 2012 Nov;6(4):174-81. doi: 10.1177/2049463712470887.
Failed back surgery syndrome (FBSS) is a generalised disorder that is characterised by chronic pain in the lower back and/or legs that persists or recurs following anatomically successful spinal surgery. This paper aims to (1) assess the burden of failed back surgery in terms of its epidemiology, impact on health outcomes and costs and (2) summarise the evidence base for the cost-effectiveness of interventions for the management of FBSS. A narrative review based on a search of MEDLINE (PubMed) up to August 2012 was undertaken. Despite advances in technology and surgical techniques and increasing rates of spine surgery, a proportion of individuals continue to suffer from FBSS. Estimates from randomised controlled trials indicate that 5-50% of patients may have an unsuccessful outcome following lumbar spinal surgery. The understanding of the epidemiology and burden of FBSS remains poor and further research is needed in this area. The impact of FBSS on an individual's health-related quality of life and its economic cost to society are considerable and more disabling than other common chronic pain and chronic medical conditions, such as heart failure and motor neuron disease. There is a substantive body of evidence in FBSS patients showing spinal cord stimulation (SCS) to be cost-effective (<£10,000 per quality-adjusted life year). In 2008, the National Institute for Health and Clinical Excellence recommended SCS as a treatment option for FBSS, either as an alternative to further lumbar surgery or as an adjunct to conservative medical management. The clinical and cost-effectiveness of SCS in the subgroup of those with FBSS receiving workers' compensation remains less clear. Intrathecal morphine pumps may also be a potentially cost-effective strategy for FBSS. The findings of this review emphasise the importance of identifying strategies to prevent the development of FBSS and effective guidelines for the management of established FBSS. The continued development and application of new neuromodulation therapies and technological innovations in the field of FBSS need to be accompanied by the collection of clinical and economic data in order to demonstrate to healthcare policy makers and payers that such innovations provide benefit to the patient at good value for money.
腰椎手术失败综合征（FBSS）是一种全身性疾病，其特征是在解剖学上成功的脊柱手术后，下背部和/或腿部持续或反复出现慢性疼痛。本文旨在：（1）从流行病学、对健康结局和成本的影响方面评估腰椎手术失败的负担；（2）总结FBSS管理干预措施成本效益的证据基础。我们基于对截至2012年8月的MEDLINE（PubMed）的检索进行了叙述性综述。尽管技术和手术技术有所进步，脊柱手术率不断上升，但仍有一部分人患有FBSS。随机对照试验的估计表明，5%-50%的患者腰椎手术后可能预后不佳。对FBSS的流行病学和负担的了解仍然不足，该领域需要进一步研究。FBSS对个人健康相关生活质量的影响及其对社会的经济成本相当大，且比其他常见的慢性疼痛和慢性疾病（如心力衰竭和运动神经元病）更具致残性。有大量证据表明，FBSS患者的脊髓刺激（SCS）具有成本效益（每质量调整生命年<10,000英镑）。2008年，英国国家卫生与临床优化研究所推荐SCS作为FBSS的一种治疗选择，可作为进一步腰椎手术的替代方案或作为保守药物治疗的辅助手段。SCS在接受工伤赔偿的FBSS亚组中的临床和成本效益仍不太明确。鞘内吗啡泵也可能是一种对FBSS潜在具有成本效益的策略。本综述的结果强调了确定预防FBSS发生的策略以及已确诊FBSS管理的有效指南的重要性。在FBSS领域，新的神经调节疗法和技术创新的持续发展和应用需要伴随着临床和经济数据的收集，以便向医疗保健政策制定者和支付者证明这些创新能以良好的性价比为患者带来益处。
