Anesth Pain Med.  2024 Jan;19(1):12-23. 10.17085/apm.23122.

Multimodal management strategies for chronic pain after spinal surgery: a comprehensive review

• Yoon JP
• Son HS
• Lee J
• Byeon GJ

• KMID: 2552853
• DOI: http://doi.org/10.17085/apm.23122

Abstract

“Chronic pain after spinal surgery” (CPSS) is a nonspecific term for cases in which the end result of surgery generally does not meet the preoperative expectations of the patient and surgeon. This term has replaced the previous term i.e., failed back surgery syndrome. CPSS is challenging for both patients and doctors. Despite advancements in surgical techniques and technologies, a subset of patients continue to experience persistent or recurrent pain postoperatively. This review provides an overview of the multimodal management for CPSS, ranging from conservative management to revision surgery. Drawing on recent research and clinical experience, we aimed to offer insights into the diverse strategies available to improve the quality of life of CPSS patients.

Keyword

Failed back surgery syndrome; Low back pain; Combined modality therapy; Nerve block; Neuromodulation; Spinal cord stimulation; General surgery.

Figure

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  Fig. 1. (A) Anterior posterior view of caudal epidural block. (B) Lateral view of caudal epidural block. (C) Anterior posterior view of transforaminal epidural block at the left L5/S1 level. (D) Lateral view of transforaminal epidural block at the left L5/S1 level.

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  Fig. 2. (A) Anterior posterior view of lumbar medial branch block at the right L4 level. (B) Oblique view of facet joint block at the right L4/5 level.

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  Fig. 3. Epidural adhesiolysis. (A) Epidural neuroplasty catheter was inserted into anterior epidural space. (B) Initial contrast was injected via the catheter. (C) Contrast reinjection after adhesiolysis demonstrating improved spread cephalad. (D) Lateral view of contrast spread.

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