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Treatment Options for Failed Back Surgery Syndrome: An Umbrella Systematic Review of Systematic Reviews on the Effectiveness of Therapeutic Interventions.
Gallego, Hernán; Arango, Sergio; Combalia, Andrés; Fuster, Salvador; Jaramillo, Catalina; Herrera, Ana Milena.
Afiliação
  • Gallego H; Department of Spine Surgery, Clinica del Campestre and Hospital Pablo Tobón Uribe, Medellín, Colombia.
  • Arango S; Fellowship in Spine Surgery, Faculty of Medicine and Health Sciences, Universidad de Barcelona (UB), Barcelona, España.
  • Combalia A; Department of Spine Surgery, Clinica del Campestre and Hospital Pablo Tobón Uribe, Medellín, Colombia.
  • Fuster S; Department of Surgery and Medical-surgical Specialties, Faculty of Medicine and Health Sciences, Universidad de Barcelona (UB), Barcelona, España.
  • Jaramillo C; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España.
  • Herrera AM; Department of Surgery and Medical-surgical Specialties, Faculty of Medicine and Health Sciences, Universidad de Barcelona (UB), Barcelona, España.
Spine Surg Relat Res ; 8(2): 143-154, 2024 Mar 27.
Article em En | MEDLINE | ID: mdl-38618223
ABSTRACT

Background:

Failed back surgery syndrome (FBSS) is a common and incapacitating condition affecting patients with previous spine surgery in whom treatment approach can be challenging. This study aimed to summarize existing secondary studies and up-to-date randomized clinical trials (RCTs) that assess the effectiveness of available treatment options for FBSS.

Methods:

Systematic searches were carried out in five databases (PubMed, Cochrane, Scielo, Epistemonikos, and Google scholar) for all systematic reviews on the effectiveness of treatment options for FBSS published after 2012. Outcomes of interest were pain levels measured through visual analog scale or numeric rating scale, Oswestry Disability Index, and quality of life. Methodological and risk of bias assessments were performed with the AMSTAR-2 tool for systematic reviews and the Joanna Briggs Institute checklist for RCT. Prospective PROSPERO registration CRD42022307609.

Results:

Fifteen studies, seven systematic reviews, and eight RCTs met the inclusion criteria and fulfilled the methodological quality assessment. Of the 15 included studies, 8 were on neurostimulation, 4 on adhesiolysis, 4 on epidural or intrathecal injections, and 3 on other treatment modalities. The risk of bias was low in seven studies, moderate in five, and high in three.

Conclusions:

Based on this systematic overview and the considerable heterogeneity among studies, the FBSS therapeutic approach must be individualized. FBSS treatment should start with conservative management, considering the implementation of neurostimulation, a technique with the most robust evidence of effective results, in cases of refractory axial or neuropathic pain. As the last resource, in light of the evidence found, more invasive procedures or new surgical interventions are indicated.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Spine Surg Relat Res Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Colômbia País de publicação: Japão
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Spine Surg Relat Res Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Colômbia País de publicação: Japão