The persistent spinal pain syndrome type 2 describes a condition where spinal pain persists or worsens after back surgery, even though the surgery was technically successful.
This condition was previously called “Failed Back Surgery Syndrome”, which emphasizes the complex and multifactorial etiology of post-surgical pain.
How Does it Manifest?
- Chronic lower back pain with or without radiation to the legs
- Sensation of “burning”, electric shocks, tingling or weakness
- Pain that persists even months after surgery
- Sometimes worse than before the surgery
How often does it occur?
Between 10% and 50% of people who have undergone lumbar spine surgery continue to suffer persistent pain with difficulty in movement. This problem used to be called Failure of Spinal Surgery Syndrome (FBSS), but it has been renamed Persistent Spinal Pain Syndrome Type 2 (PSPS-T2).
Why Does it Happen?
Persistent pain after surgery can have several causes, including:
- Epidural fibrosis (scar tissue formation around the nerves)
- Residual or surgery-induced spinal instability
- Periradicular adhesions
- Posterior facet joint syndrome
- Pain originating from sacroiliac joints or adjacent discs
- Central pain sensitization mechanisms (neuropathic pain)
It’s not always a “surgical failure,” but often the result of multiple persistent pain mechanisms.
How is it Diagnosed?
- Detailed medical history and review of previous surgery
- Specialized clinical examination
- Imaging: Post-operative Magnetic Resonance Imaging (MRI), CT scan, electromyography (EMG)
- Interventional diagnostic techniques:
- Selective blocking of facet joints, sacroiliac joints, or nerve roots
What are the Treatment Options?
Multimodal Approach
- Targeted medications: analgesics, anti-inflammatory drugs, neuromodulators (pregabalin, duloxetine…)
- Specialized physiotherapy: functional recovery and mobility
- Psychological support for chronic pain management
- TENS
Minimally Invasive Treatments
- Epidural injections
- Pulsed radiofrequency of nerve roots or ganglia
- Denervation of facet joints or sacroiliac joint
Advanced Treatment: Neuromodulation
In selected patients, spinal cord stimulation (SCS) can dramatically reduce pain and improve quality of life. This is an implantable device that modulates pain signals at the spinal level.
Recent studies show significant effectiveness of neuromodulation in patients with PSPS-II who do not respond to other conservative or interventional therapies.
Conclusione
PSPS-II is a complex but treatable condition. The key is a multidisciplinary evaluation and a personalized approach, combining advanced diagnostic techniques and targeted therapies.