FBSS: Endoscopic Documentation of Common Causes by Visualization of Painful Patho-anatomy


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Failed back surgery syndrome is a very loose term that has different meanings to different providers and specialists treating chronic lumbar pain. Surgeons label the term after failure to obtain their projected surgical results following traditional decompression surgery and/or fusion. There are painful pathoanatomic structures in the foramen not visualized by traditional surgeons. Therefore, rather than identifying a diagnosis of the etiology of the failure, surgeons simply label it “failed back surgery syndrome”. Even recurrent HNP is sometimes missed if small or in the “hidden” foraminal zone, even when it occurs after the surgeon has visually confirmed “complete” decompression of the herniated disc fragment or stenosis.

These patients are often referred for “pain management”. Interventional pain specialists focus on the neuromodulation of the spinal cord (SCS), or more recently the dorsal root ganglion (DRG). They use percutaneous neuromodulation to block pain pathways, depending on the gate theory. The two different specialties depend on divergent treatments without knowledge of the more specific reasons for surgical failure.

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