Failed Back Surgery Syndrome: The Scar Is a Myth
The term “failed back surgery syndrome” (FBSS) is wide-ranged and includes any sequelae following surgery of a lumbar disc herniation. Symptoms might be variable and multiple reasons exist, which can lead to a FBSS. Both the axial lumbar back pain as well as the persistent radiculopathy after surgery are symptoms of the FBSS. A large-scaled study could show that the FBSS depends on a recessal stenosis in 58% of cases, on a spinal stenosis in 7–14% of cases, on a new disc herniation in 12–16% of cases, on an arachnoiditis in 6–16% of cases, and on epidural scars in 6–8% of patients. As described later, the latter must be questioned. In most cases the pain occurs under stress and differs from the preoperative symptoms. Multiple operative and non-operative strategies can be chosen for the therapy of FBSS, but they only lead to a satisfying result if they are adapted to the underlying reason. Hence, making the diagnosis and the right indication particularly for the operative therapy of the FBSS is complex.
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