Non-Invasive Treatments for Failed Back Surgery Syndrome: A Systematic Review

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  • Giuseppe Francesco Papalia
    Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
  • Fabrizio Russo
    Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
  • Gianluca Vadalà
    Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
  • Giuseppe Pascarella
    Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
  • Sergio De Salvatore
    Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
  • Luca Ambrosio
    Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
  • Sara Di Martino
    Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
  • Davide Sammartini
    Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
  • Emanuele Sammartini
    Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
  • Massimiliano Carassiti
    Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
  • Rocco Papalia
    Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
  • Vincenzo Denaro
    Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy

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<jats:sec><jats:title>Study design</jats:title><jats:p> Systematic Review. </jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p> The aim of this systematic review is to evaluate the efficacy of non-invasive procedures in relieving chronic pain due to Failed Back Surgery Syndrome (FBSS). </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Since patients who suffered from FBBS are often non-responders to analgesics, we compared Visual Analogical Scale for low back and leg pain, Oswestry Disability Index, trial success rate, adverse events and complications between conservative treatment groups and control groups. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> The included studies were 15. Spinal Cord Stimulation (SCS) was performed in 11 trials; 4 studies assessed the efficacy of different epidural injections; one study evaluated repetitive Transcranial Magnetic Stimulation. All the studies reported back and leg pain relief after treatment with SCS, with a significant superiority in high frequences (HFS) group, compared to low frequences (LFS) group. Moreover, disability decreased with each non-invasive treatment evaluated. Epidural injections of steroids and hyaluronidase have shown controversial results. Adverse events were described in 7 studies: lead migration, hardware-related events, infection and incisional pain were the most reported. Finally, trial success rate showed better outcomes for HFS. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Our systematic review highlights the efficacy of conservative treatments in FBSS patients, with an improvement in pain scores and a decrease in disability index, especially after SCS with HFS. However, due to the lack of homogeneity among trials and population characteristics, further studies are needed to confirm the effectiveness of non-invasive interventions in patients affected by FBSS. </jats:p></jats:sec>

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