Failed back surgery syndrome: surgical and nonsurgical approaches.

UNLABELLED: Failed Back Surgery Syndrome is a common and challenging clinical problem. Often the anatomic pain source is unclear. Relevant outcome studies are rarely diagnosis specific, and high level research studies comparing surgical and nonsurgical approaches to Failed Back Surgery Syndrome studies have not been published to date. Surgical strategies focus on decompressing neural impingement or fusing unstable or putatively painful intervertebral discs. Nonsurgical interventions range from nerve root specific blocks for pain relief to multidisciplinary rehabilitation programs geared toward improving function. This paper reviews the most common interventions and concludes with recommendations for the care of the individual patient. LEVEL OF EVIDENCE: Level V (expert opinion). See the Guidelines for Authors for a complete description of the levels of evidence.