Anesth Pain Med.  2018 Oct;13(4):363-371. 10.17085/apm.2018.13.4.363.

Current strategy for chronic pain after spinal surgery

• Park YH
• Choi EJ

• KMID: 2435993
• DOI: http://doi.org/10.17085/apm.2018.13.4.363

Abstract

Failed back surgery syndrome was recently renamed, as chronic pain after spinal surgery (CPSS) by international classification of disease-11. CPSS is a challenging clinical condition. It has a variety of causes associated with preoperative, intraoperative and postoperative periods. Also, psychosocial factors should be considered. Diagnostic tools must be used differently, for each patient. Imaging and interventional nerve block for diagnosis, should be used properly. Strategy of management requires a multidisciplinary approach. The effect of conservative management (medication, interventional management) and invasive procedure (spinal cord stimulator, intrathecal drug delivery system) has been studied by many researchers. However, an evidence-based guide on management of CPSS, remains necessary, and further research is needed. This review focuses on understanding and clinical approaches for CPSS.

Keyword

Failed back surgery syndrome; Nerve block; Pain management; Spinal cord stimulation

MeSH Terms

Chronic Pain*
Classification
Diagnosis
Failed Back Surgery Syndrome
Humans
Nerve Block
Pain Management
Postoperative Period
Psychology
Spinal Cord Stimulation

Figure

• 

  Fig. 1 Proposed algorithm for chronic pain after spinal surgery. CT: computed tomography, MRI: magnetic resonance imaging, SPECT: single photon emission computed tomography, FJ: facet joint, SI: sacroiliac joint, IDD: internal derangement of disc, ESI: epidural steroid injection, TFESI: transforaminal epidural steroid injection, MBB: medial branch block, PEA: percutaneous epidural adhesiolysis, EEA: endoscopic epidural adhesiolysis, RF: radiofrequency, IDET: intradiscal electrothermal treatment, SCS: spinal cord stimulator, ITDDS: intrathecal drug delivery system.

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