Witkam Richard L, Buckens Constantinus F, van Goethem Johan W M, Vissers Kris C P, Henssen Dylan J H A
Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Insights Imaging. 2022 Jul 15;13(1):117. doi: 10.1186/s13244-022-01246-z.
Failed back surgery syndrome (FBSS) is an umbrella term referring to painful sensations experienced by patients after spinal surgery, mostly of neuropathic nature. Adequate treatment of FBSS is challenging, as its etiology is believed to be multifactorial and still not fully clarified. Accurate identification of the source of pain is difficult but pivotal to establish the most appropriate treatment strategy. Although the clinical utility of imaging in FBSS patients is still contentious, objective parameters are highly warranted to map different phenotypes of FBSS and tailor each subsequent therapy.
Since technological developments have weakened the applicability of prior research, this educational review outlined the recent evidence (i.e., from January 2005 onwards) after a systematic literature search. The state of the art on multiple imaging modalities in FBSS patients was reviewed. Future directions related to functional MRI and the development of imaging biomarkers have also been discussed.
Besides the fact that more imaging studies correlated with symptomatology in the postoperative setting are warranted, the current educational review outlined that contrast-enhanced MRI and MR neurography have been suggested as valuable imaging protocols to assess alterations in the spine of FBSS patients. The use of imaging biomarkers to study correlations between imaging features and symptomatology might hold future potential; however, more research is required before any promising hypotheses can be drawn.
腰椎手术失败综合征（FBSS）是一个统称，指脊柱手术后患者所经历的疼痛感觉，大多具有神经病理性。FBSS的充分治疗具有挑战性，因为其病因被认为是多因素的且仍未完全阐明。准确识别疼痛来源虽困难但对于制定最合适的治疗策略至关重要。尽管影像学在FBSS患者中的临床效用仍存在争议，但客观参数对于描绘FBSS的不同表型并为后续每种治疗量身定制方案非常必要。
由于技术发展削弱了先前研究的适用性，本教育性综述在系统文献检索后概述了近期证据（即2005年1月起）。对FBSS患者多种成像模态的最新进展进行了综述。还讨论了与功能磁共振成像及成像生物标志物发展相关的未来方向。
除了需要更多与术后症状相关的影像学研究这一事实外，当前的教育性综述指出，对比增强磁共振成像和磁共振神经造影已被建议作为评估FBSS患者脊柱改变的有价值的成像方案。使用成像生物标志物研究成像特征与症状之间的相关性可能具有未来潜力；然而，在得出任何有前景的假设之前还需要更多研究。
