Cho Jae Hwan, Lee Jae Hyup, Song Kwang Sup, Hong Jae-Young, Joo Yoon-Suk, Lee Dong-Ho, Hwang Chang Ju, Lee Choon Sung
Department of Orthopedic Surgery, Asan Medical Center University of Ulsan, College of Medicine, Seoul, Korea.
Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, College of Medicine and Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea.
Pain Physician. 2017 Jan-Feb;20(1):E29-E43.
Failed back surgery syndrome (FBSS) is a frequently encountered disease entity following lumbar spinal surgery. Although many plausible reasons have been investigated, the exact pathophysiology remains unknown. Various medications, reoperations, interventions such as spinal cord stimulation, epidural adhesiolysis or epidural injection, exercise therapy, and psychotherapy have been suggested treatment options. However, the evidence of the clinical outcome for each treatment has not been clearly determined.
To evaluate the outcomes of each treatment modality and to present treatment guidelines for patients with FBSS.
A systematic review of each treatment regimen in patients with FBSS.
The available literature regarding each modality for the treatment of refractory back pain or radiating pain for FBSS was reviewed. The quality assessment and the level of evidence were analyzed using the "Methodology Checklist" of SIGN (Scottish Intercollegiate Guidelines Network). Data sources included relevant English language literature identified through searches of Pubmed, EMBASE, and Cochrane library from 1980 to Feb 2016. The primary outcome measure was pain relief of back pain or radiating pain for at least 3 months. Secondary outcome measures were improvement of the patient's functional status, health-related quality of life, return to work, and reduction of opioid use.
Twenty-three articles were finally identified and reviewed. Based on our analysis, epidural adhesiolysis showed a short-term (6 to 24 months) effect (grade A) and spinal cord stimulation showed a mid-term (2 or 3 years) effect (grade B). Epidural injections showed a short-term (up to 2 years) effect (grade C). However, other treatments were recommended as grade D or inconclusive.
The limitations of this systematic review included the rarity of relevant literature.
Epidural adhesiolysis or spinal cord stimulation can be effective in order to control chronic back pain or leg pain due to FBSS, and its recommendation grades are A and B, respectively. Other treatments showed poor or inconclusive evidence.Key words: Failed back surgery syndrome, post spinal surgery syndrome, chronic low back pain, post lumbar surgery syndrome, epidural adhesiolysis, spinal cord stimulation, epidural injection, revision.
腰椎手术后失败综合征（FBSS）是腰椎手术后常见的疾病实体。尽管已经研究了许多可能的原因，但其确切的病理生理学仍不清楚。各种药物、再次手术、脊髓刺激、硬膜外粘连松解或硬膜外注射等干预措施、运动疗法和心理治疗都被建议作为治疗选择。然而，每种治疗方法的临床疗效证据尚未明确确定。
评估每种治疗方式的疗效，并为FBSS患者提供治疗指南。
对FBSS患者的每种治疗方案进行系统评价。
回顾了关于治疗FBSS难治性背痛或放射性疼痛的每种方式的现有文献。使用苏格兰校际指南网络（SIGN）的“方法检查表”分析质量评估和证据水平。数据来源包括通过检索1980年至2016年2月的PubMed、EMBASE和Cochrane图书馆确定的相关英文文献。主要结局指标是背痛或放射性疼痛缓解至少3个月。次要结局指标包括患者功能状态的改善、与健康相关的生活质量、重返工作岗位以及阿片类药物使用的减少。
最终确定并回顾了23篇文章。根据我们的分析，硬膜外粘连松解显示出短期（6至24个月）疗效（A级），脊髓刺激显示出中期（2或3年）疗效（B级）。硬膜外注射显示出短期（长达2年）疗效（C级）。然而，其他治疗被推荐为D级或证据不明确。
本系统评价的局限性包括相关文献稀少。
硬膜外粘连松解或脊髓刺激对于控制FBSS引起的慢性背痛或腿痛可能有效，其推荐等级分别为A级和B级。其他治疗的证据不佳或不明确。关键词：腰椎手术后失败综合征、脊柱手术后综合征、慢性下腰痛、腰椎手术后综合征、硬膜外粘连松解、脊髓刺激、硬膜外注射、翻修术
