patient expectations

Refractory Back Pain after Surgery: an Overview of the Failed Back Surgery Syndrome (FBSS)


1Zhi Wang BSc, MSc MD FRCSC, 2Ali Ghoul MD, 3Jesse Shen MD, PhD Candidate, 4Amer Sebaaly MSc, MD,

1Associate Professor, Montreal University (CHUM), Montreal, Quebec. 2PGY 3 Orthopaedic Resident, Saint Joseph University, Beirut Lebanon. 3PGY 5 Montreal University, Montreal Quebec. 4Orthopedic Lecturer, Saint Joseph University, Beirut, Lebanon.


Abstract: “Lumbar spinal pain of unknown origin, either persisting despite surgical intervention or appearing after surgical intervention for spinal pain, originating in the same topographical location” is a description widely used to describe Failed Back Surgery Syndrome (FBSS). In reality, the syndrome is more often a mismatch between the patient’s expectations and the surgical results. This review will describe the possible causes and presentation of FBSS and highlight the role of the multidisciplinary team approach in its management involving non-operative and surgical interventions. The most important objective is correct patient selection for surgery before the first operation.
Key Words: Failed Back Surgery Syndrome, multi-disciplinary approach, spine surgery, low back pain, patient expectations.

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1. Fusing even a short segment of the spine can have significant, possibly deleterious effects, on the complex spinal functions.
2. The Failed Back Syndrome is often a mismatch between the patient's expectations and the final result rather than a failure of surgical technique.
3. The poor result may be the result of preoperative, intraoperative or postoperative factors. All three areas must be assessed.
4. Correct patient selection is as important or even more important than the surgical approach.
The incidence of Failed Back Surgery Syndrome ranges from 10-40% after a major spinal operation.
Setting the preoperative expectations with a full discussion between the patient, referring physician and operating surgeon plays a key role.
There are three periods – pre-operative, intra-operative, post-operative–in which FBSS can arise.
Proper patient selection and pre-operative optimization of all modifiable factors improve outcomes and decrease the possibility of FBSS.
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