Affiliations: Discipline of Physiotherapy, School of Medicine, Trinity Centre for Health Sciences, St James Hospital, Dublin, Ireland
Correspondence:
[*]
Corresponding author: Ciara Clancy, Discipline of Physiotherapy, School of Medicine, Trinity Centre for Health Sciences, St James Hospital, Dublin 8, Ireland. Tel.: +353 879191756; E-mail:ciclancy@tcd.ie
Abstract: PURPOSE:
Four to fifty percent of patients will develop Failed Back Surgery Syndrome
(FBSS) following lumbar spine surgery. Repeated surgeries lead to escalating
costs and subsequent decreases in success rate. Much of the research to date
has focused on the psychosocial factors associated with FBSS. All factors
including physical and pathological aetiologies should be examined. These
factors may be independent, co-exist with or predispose patients to the
psychological factors associated with FBSS. Previous reviews on the topic
have been limited by a lack of systematic overview. The aim of this review
is to identify the physical, physiological and pathological aetiologies of
FBSS.
METHODS:
This review was done in accordance with the PRISMA guidelines. A
computer-aided search of the electronic databases from inception to December
2014 was performed. Outcome measures of interest included pain, functional
and radiological assessments. Two reviewers independently selected studies
for inclusion. Methodological quality was assessed using the Newcastle
Ottawa Scale.
RESULTS:
Six studies met the inclusion criteria and included a total of 663 patients.
A total of twenty two aetiologies were identified. Only three studies
reviewed non-surgical aetiologies. Many of the studies relied on medical
imaging to identify the aetiologies. A meta-analysis was not undertaken due
to the heterogeneity of studies.
CONCLUSIONS:
The causes of FBSS can be attributed to patho-anatomical, peripheral pain
generators, physical/ mechanical, neurophysiological, surgical and `other'
aetiologies. Three of the studies only examined surgical causes of FBSS.
Further research, that examines surgical and non-surgical aetiologies, is
required to draw firm conclusions. With nineteen aetiologies identified,
FBSS remains an unclear diagnosis for a complex heterogeneous group of
patients.
