Optimizing the Management and Outcomes of Failed Back Surgery Syndrome: A Consensus Statement on Definition and Outlines for Patient Assessment

Abstract

Failed back surgery syndrome (FBSS) is a controversial term for identifying patients affected by new, recurrent, or persistent pain in the low back and/or legs following spinal surgery. The lack of a comprehensive standardized care pathway compromises the appropriate management of FBSS patients, which is associated with a heavy financial burden. An international panel of spine surgeons, neurosurgeons, and pain specialists with a particular interest in FBSS established the chronic back and leg pain (CBLP) network with the aim of addressing the challenges and barriers in the clinical management of FBSS patients by building a common transdisciplinary vision. Based on literature reviews, additional input from clinical expertise of multiple professional disciplines, and consensus among its members, the network attempted to provide recommendations on the management of patients with FBSS utilizing a multidisciplinary team (MDT) approach. The presentation of this work has been divided in two separate parts to enhance its clarity. This first paper, in favour of selecting appropriate validated tools to improve the FBSS patient assessment, focuses on FBSS taxonomy and its clinical implications for evaluation. Concise recommendations for assessment, treatment, and outcome evaluation using a MDT approach would be an important resource for specialists and nonspecialist clinicians who manage patients with FBSS, to improve decision-making, reduce variation in practice, and optimize treatment outcomes in this difficult-to-treat population.

Figure 1

Schematic diagram of steps in the literatures searches: FBSS definition and evaluation. The electronic and hand literature searches yielded 1663 titles and 74 textbooks. Following a review of full-text versions of the 363 residual publications, after discarding duplicates and initial exclusion of 1300 titles/abstracts, 108 papers were finally selected, and 12 were retained for FBSS definition and MDT assessment and composition (Supplementary Material 1).

Figure 2

The initial stage of the proposed standardized multidisciplinary team failed back surgery syndrome care pathway, as recommended by the Chronic Back and Leg Pain Network. Clinical evaluation and confirmation of diagnosis. FBSS, failed back surgery syndrome; MDT, multidisciplinary team. ¹Best practice is for the psychosocial evaluation to be performed by a psychologist or psychiatrist with specific experience in the field of pain. Assessment should include the relevant tests and questionnaires that are able to identify patients with major psychological or psychiatric contraindications (Table 3).