CHRONIC LOW-BACK-PAIN FOLLOWING DISC SURG ERY

The failed back surgery syndrome occurs in about 5-30% of lumbar disk surgeries and consists essentially in chronic post-surgery pain that c annot be attributed to the primary process causative for radicular sym ptoms. In Germany about 20% of the notifications of illness and 50% of premature retirements are due to back pain. An undetermined portion o ccurs following disk surgery. Acute and subacute pain after disk surge ry reminds us primarily of recurrences of disk disk herniation, epidur al hemorrhage, and spondylodiscitis. Chronic pain calls for other etio logies, mainly the question of whether the primary indication for surg ery was not correct (around a quarter of failed back surgery syndromes ), or an instability of the spine, epidural scar formation, and muscul ar weakness. Beyond that other etiologies have to be taken into accoun t, like major depression, psychological and social factors, and drug a buse. All kinds of invasive therapy, especially the surgical stabilisa tion of the spine in cases of instability have to be taken into consid eration very carefully. Unfortunately there doesn't exist any interdis ciplinary approach to validate the outcome following this kind of surg ery.