Failed back surgery syndrome: what's in a name? A proposal to replace “FBSS” by “POPS”…

Rigoard, P., Desai, M.J. and Taylor, R. S. (2015) Failed back surgery syndrome: what's in a name? A proposal to replace “FBSS” by “POPS”…. Neurochirurgie, 61, S16-S21. (doi: 10.1016/j.neuchi.2014.12.001) (PMID:25665773)

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Background: The current definition of Failed Back Surgery Syndrome (FBSS) has a pejorative and restrictive connotation of blame and failure. Optimally, the evaluation of FBSS patients might be based on a multidimensional approach, involving an array of practitioners including spine surgeons, pain physicians, physiotherapists and behavioural specialists. Even though these clinical interactions should lead to a unique approach, one main problem comes from the fact that FBSS definition has varied over time and remains extremely controversial. There is now a need for global consensus about what we call FBSS, why, when and how. Discussing the name of this syndrome appears to be a logical starting point. Discussion: “PostOperative Persistent Syndrome”, summarised by the acronym “POPS”, could be an appropriate term to not only encapsulate failure but pain, function and psychosocial dysfunction following unsuccessful spine surgery whether from a technical or expectation standpoint. A return to the source might help to identify the real clinical problem, i.e. the pain mechanism: nociceptive, neuropathic pain or mixed. A clinical and radiological spine assessment is key to ensure that no further surgery is required, by distinguishing within the so-called FBSS population, “true” FBSS patients and “potential” FBSS patients, who are actually not FBSS patients, as an aetiological treatment of potential pain generators still remains possible. Conclusion: We propose to replace the FBSS acronym by POPS. The ultimate goal of this redefinition would be to guide the patient towards the future rather than the past and to reach a consensus, based on network discussions, concerning the following items: integrate pain mechanisms into the diagnostic process; implement the notion of a predominant ratio between mechanical/neuropathic pain mechanisms, which defines the potential target for treatment options; create a network supported by a database, to prospectively pool and analyse data, using homogeneous evaluation tools and ultimately define outcome predictors in this population.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Taylor, Professor Rod
Authors: Rigoard, P., Desai, M.J., and Taylor, R. S.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:Neurochirurgie
ISSN (Online):1773-0619
Published Online:07 February 2015

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