Using gabapentin to treat failed back surgery syndrome caused by epidural fibrosis: A report of 2 cases

Failed back surgery syndrome (FBSS) is a long-lasting, often disabling, and relatively frequent (5%-10%) complication of lumbosacral spine surgery. Ep idural fibrosis is among the most common causes of FBSS, and it is often re calcitrant to treatment. Repeated surgery fur fibrosis has only a 30% to 35 % success rate, whereas 15% to 20% of patients report worsening of their sy mptoms. Long-term outcome studies focusing on pharmacologic management of c hronic back pain secondary to epidural fibrosis are lacking in the literatu re. This report presents 2 cases of severe epidural fibrosis managed succes sfully with gabapentin monotherapy. In both cases, functional status improv ed markedly and pain was significantly diminished. Gabapentin has an establ ished, favorable safety profile and has been shown to be effective in vario us animal models and human studies of chronic neuropathic pain. Clinicians should consider gabapentin as a pharmacologic treatment alternative in the management of FBSS caused by epidural fibrosis.