Management of back pain in patients with previous back surgery

The 80,000 or so patients a year who continue to have chronic, disabling back pain after one or more spinal surgeries are said to have failed back surgery syndrome. There are no controlled studies to guide physicians in the management of these patients. Six anatomical abnormalities of the spine most commonly result in back surgery, and 7 undesirable outcomes lead to failed back surgery syndrome. On the basis of 5 large retrospective studies and our clinical experience, we suggest a systematic approach to these patients. This approach is focused on determination of the specific anatomical abnormality responsible for ongoing symptoms, an abnormality that may or may not be related to the initial abnormality for which surgery was performed. One or more of 5 nonsurgical treatment options may be useful to prevent the need for further surgery, as each subsequent surgery has a lower likelihood of success. (C) 2008 Elsevier Inc. All rights reserved.