Managing chronic pain of spinal origin after lumbar surgery: the role of decompressive surgery.

STUDY

DESIGN

A literature review was conducted.

OBJECTIVE

To provide an evidence-based approach for patients with neurogenic symptoms after lumbar surgery.

SUMMARY OF BACKGROUND DATA: Patients may present with chronic pain of spinal origin after lumbar surgery. Failure to decompress the involved neural structures adequately or progression of the underlying degenerative condition may lead to neurologic symptoms.

METHODS

A literature search of peer-reviewed publications that investigate etiologies and treatments for neurogenic pain in patients who have undergone previous spinal surgery was conducted.

RESULTS

In the absence of profound or progressive neurologic deficits, most patients with chronic back and leg pain who have undergone previous spinal surgery should be treated nonoperatively. Additional decompressive surgical intervention may be justified in patients with well-defined, discrete pathology amenable to surgical correction who have been refractory to conservative care. The surgery typically will include meticulous decompression of the affected neural structures and may include arthrodesis to address any deformity or instability.

CONCLUSIONS

In a patient presenting with neurogenic symptoms after lumbar surgery, a meticulous workup is required to elucidate the source of these symptoms. Surgical indications are similar to those for primary lumbar spinal surgery and include a well-defined anatomic source of neural compression that is amenable to a surgical solution.