The failed back--an orthopaedic view.

The causes of the failed back syndrome are several. The failure to appropriately identify the structural sources of pain is one. The identities may include radiographically controlled injection procedures. The failure to use sufficiently discrete surgery with an attempt to avoid scar is another cause and the failure to provide an opportunity to avoid and later treat deconditioning is another. The appropriate treatment programme is based on objective assessment of function. Functional achievement as the principal care rather than pain self-report is the most effective manoeuvre to avoid the chronic pain of the failed back syndrome.