Abstract
The failed back surgery syndrome (FBSS) diagnosis has been applied to patients with unrelieved persistent pain following lumbar spine surgery and/or surgeries. FBSS becomes an important and serious disease in contemporary medicine, both from medical and socialeconomical view.
Over the years, a number of treatments the FBSS have been developed. The syndrome is very difficult to treat due to the variability of pain generators.
A precise diagnosis is the primary goal before starting the treatment. Derivation of a treatment modalities is made difficult because the cause or causes of pain cannot be often precisely defined.
More rigorous studies (evidence based medicine) have led to improved understanding of new pharmacological, surgical and neuromodulation therapies of FBSS. Results of these methods have not been still enough effective.
Outcomes of most treatments have been inconclusive. Although many therapies exist, there remains no standard treatment strategy (algorithm of treatment of FBSS).
From this point of view a multidisciplinary approach is necessary. The psychologist and psychiatrist are important to detect and treat psychological sources in FBSS.
Treating metaor of FBSS are described in this article. The stress is done on the (neuro)surgery treatment and neuromodulation, especially on neurostimulation of spinal cord (spinal cord stimulation - SCS).
Examination of the anatomy and pathophysiology of the pain mechanism and examination of the multifocal generators of this syndrome is a logical progression of possible algorithm. Clinical efforts over last year have focused on procedure refinements, clarification of outcomes, improved of patient selection for existing therapies, especially for invasive procedures and on the development of novel therapies.
These efforts have begun to clarify the clinical use of existing therapies and should provide and improve basis for future developments in the diagnosis and treatment of FBSS and should form a suitable and available algorithms