Highlights
- •Failed back surgery syndrome (FBSS) is a significant of patient morbidity.
- •There is a lack of consensus regarding the diagnosis of FBSS.
- •FBSS is more common in the inpatient vs. outpatient setting.
- •FBSS is more common after multi-level procedures than single-level procedures.
- •FBSS is common in decompression procedures.
Abstract
Background
Failed back surgery syndrome (FBSS) is a significant cause of lumbar disability and
is associated with severe patient morbidity. As the etiology of FBSS is not completely
elucidated, the risk factors and evaluation of patients with FBSS remains challenging.
Our analysis of a wide variety of operation types, clinical setting, and their correlation
to FBSS seeks to allow fellow clinicians to be aware of the potential risk factors
that leads to this devastating diagnosis.
Methods
Data were obtained for patients undergoing anterior lumbar fusion, posterior lumbar
fusion, or decompression procedures from January 2010 to December 2017 from the Mariner
insurance database. Rates of FBSS at six- and twelve-months post-surgery were determined
for patients undergoing single/multilevel procedures according to place of service,
and approach/procedure type.
Results
From 2010 to 2017, 102,047 patients underwent lumbar fusion or decompression surgery
(54% decompression procedures, 36% posterior fusions, and 8.9% anterior fusions). 5.4% of patients were diagnosed with FBSS within six months of the index procedure,
and 8.4% were diagnosed with FBSS within twelve months. FBSS was higher in the inpatient
(6.0%) vs. outpatient (4.3%) cohort. Among the surgical techniques, multi-level procedures
had significantly higher rates of FBSS than single-level procedures, the highest being
10% in multi-level inpatient decompression procedures (p < 0.05).
Conclusion
The highest rates of FBSS occurred in in the elderly (age group 70–74), for those
patients whose index procedure was received in an inpatient setting, as well as for
those receiving a multi-level surgery.
Keywords
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Article info
Publication history
Accepted:
June 28,
2022
Received:
April 28,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
