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Review
. 2023 May;13(4):1153-1162.
doi: 10.1177/21925682221141385. Epub 2022 Nov 22.

Non-Invasive Treatments for Failed Back Surgery Syndrome: A Systematic Review

Giuseppe Francesco Papalia  1 , Fabrizio Russo  1 , Gianluca Vadalà  1 , Giuseppe Pascarella  2 , Sergio De Salvatore  1 , Luca Ambrosio  1 , Sara Di Martino  2 , Davide Sammartini  2 , Emanuele Sammartini  2 , Massimiliano Carassiti  2 , Rocco Papalia  1 , Vincenzo Denaro  1
Affiliations
Review

Non-Invasive Treatments for Failed Back Surgery Syndrome: A Systematic Review

Giuseppe Francesco Papalia et al. Global Spine J. 2023 May.

Abstract

Study design: Systematic Review.

Objectives: The aim of this systematic review is to evaluate the efficacy of non-invasive procedures in relieving chronic pain due to Failed Back Surgery Syndrome (FBSS).

Methods: Since patients who suffered from FBBS are often non-responders to analgesics, we compared Visual Analogical Scale for low back and leg pain, Oswestry Disability Index, trial success rate, adverse events and complications between conservative treatment groups and control groups.

Results: The included studies were 15. Spinal Cord Stimulation (SCS) was performed in 11 trials; 4 studies assessed the efficacy of different epidural injections; one study evaluated repetitive Transcranial Magnetic Stimulation. All the studies reported back and leg pain relief after treatment with SCS, with a significant superiority in high frequences (HFS) group, compared to low frequences (LFS) group. Moreover, disability decreased with each non-invasive treatment evaluated. Epidural injections of steroids and hyaluronidase have shown controversial results. Adverse events were described in 7 studies: lead migration, hardware-related events, infection and incisional pain were the most reported. Finally, trial success rate showed better outcomes for HFS.

Conclusions: Our systematic review highlights the efficacy of conservative treatments in FBSS patients, with an improvement in pain scores and a decrease in disability index, especially after SCS with HFS. However, due to the lack of homogeneity among trials and population characteristics, further studies are needed to confirm the effectiveness of non-invasive interventions in patients affected by FBSS.

Keywords: Failed back surgery syndrome; low back pain; non-invasive treatments; spinal cord stimulation; systematic review.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Preferred reporting items for systematic review and meta-analysis (PRISMA) flow diagram.
See this image and copyright information in PMC

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