Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
Anesthesiology and Pain Medicine, Elisabeth-Tweesteden Ziekenhuis, Tilburg, The Netherlands.
Pain Pract. 2024 Sep;24(7):919-936. doi: 10.1111/papr.13379. Epub 2024 Apr 14.
Persistent Spinal Pain Syndrome (PSPS) refers to chronic axial pain and/or extremity pain. Two subtypes have been defined: PSPS-type 1 is chronic pain without previous spinal surgery and PSPS-type 2 is chronic pain, persisting after spine surgery, and is formerly known as Failed Back Surgery Syndrome (FBSS) or post-laminectomy syndrome. The etiology of PSPS-type 2 can be gleaned using elements from the patient history, physical examination, and additional medical imaging. Origins of persistent pain following spinal surgery may be categorized into an inappropriate procedure (eg a lumbar fusion at an incorrect level or for sacroiliac joint [SIJ] pain); technical failure (eg operation at non-affected levels, retained disk fragment, pseudoarthrosis), biomechanical sequelae of surgery (eg adjacent segment disease or SIJ pain after a fusion to the sacrum, muscle wasting, spinal instability); and complications (eg battered root syndrome, excessive epidural fibrosis, and arachnoiditis), or undetermined.
The literature on the diagnosis and treatment of PSPS-type 2 was retrieved and summarized.
There is low-quality evidence for the efficacy of conservative treatments including exercise, rehabilitation, manipulation, and behavioral therapy, and very limited evidence for the pharmacological treatment of PSPS-type 2. Interventional treatments such as pulsed radiofrequency (PRF) of the dorsal root ganglia, epidural adhesiolysis, and spinal endoscopy (epiduroscopy) might be beneficial in patients with PSPS-type 2. Spinal cord stimulation (SCS) has been shown to be an effective treatment for chronic, intractable neuropathic limb pain, and possibly well-selected candidates with axial pain.
The diagnosis of PSPS-type 2 is based on patient history, clinical examination, and medical imaging. Low-quality evidence exists for conservative interventions. Pulsed radiofrequency, adhesiolysis and SCS have a higher level of evidence with a high safety margin and should be considered as interventional treatment options when conservative treatment fails.
持续性脊柱疼痛综合征（PSPS）是指慢性的轴性疼痛和/或四肢疼痛。已定义了两种亚型：PSPS 型 1 为无先前脊柱手术的慢性疼痛，PSPS 型 2 为脊柱手术后持续存在的慢性疼痛，以前称为失败的脊柱手术综合征（FBSS）或椎板切除术后综合征。PSPS 型 2 的病因可以从病史、体格检查和其他医学影像学中获得。脊柱手术后持续性疼痛的起源可以分为不当的手术程序（例如，在错误的水平进行腰椎融合术或用于治疗骶髂关节[SIJ]疼痛）；技术失败（例如，在非受累水平进行手术、残留椎间盘碎片、假关节）、手术的生物力学后遗症（例如融合到骶骨后的相邻节段疾病或 SIJ 疼痛、肌肉萎缩、脊柱不稳定）；和并发症（例如神经根综合征、硬膜外纤维化和蛛网膜炎），或未确定的原因。
检索并总结了关于 PSPS 型 2 的诊断和治疗的文献。
对于包括运动、康复、手法和行为疗法在内的保守治疗方法的疗效有低质量的证据，对于 PSPS 型 2 的药物治疗仅有非常有限的证据。介入治疗方法，如背根神经节的脉冲射频（PRF）、硬膜外松解术和脊柱内窥镜（硬膜外镜检查），可能对 PSPS 型 2 患者有益。脊髓刺激（SCS）已被证明是治疗慢性、难治性神经性肢体疼痛的有效方法，对于选择合适的轴向疼痛患者可能也有效。
PSPS 型 2 的诊断基于病史、临床检查和医学影像学。对于保守干预有低质量的证据。脉冲射频、松解术和 SCS 具有更高水平的证据和更高的安全边际，当保守治疗失败时，应将它们视为介入治疗的选择。
