BACKGROUND
Chronic back pain is a very common reason that causes people to seek medical help. Some patients require surgical treatment of chronic pain. However, almost 50% of patients still experience pain after a flawlessly performed operation. This condition is referred to as Failed Back Surgery Syndrome (FBSS). The article discusses neurological aspects and non-surgical factors influencing the persistence of pain in patients who have undergone microdiscectomy on the lumbar spine, which include disturbances in postural balance, the presence of comorbid pain syndromes, the severity of central sensitization, as well as autonomic and affective disorders.
MATERIAL AND METHODS
A comparative analysis of the clinical characteristics of the pain syndrome, the presence of comorbid pain syndromes, data from manual muscle testing and postural balance, as well as affective and autonomic disorders was carried out in patients with FBSS (main group), patients with discogenic radiculopathy without a history of surgery (comparison group) and patients who underwent microdiscectomy, but who do not have pain after surgery (control group). The groups were comparable in terms of age and sex characteristics.
RESULTS
Patients with FBSS had symptoms of prolapse involving a larger number of spinal segments of the lesion; pelvic disorders were more common in the main group. The intensity of pain in the main group was significantly lower than in the comparison group, however, the degree of maladjustment according to the Oswestry questionnaire in the main group was comparable to the comparison group. The representation of comorbid pain syndromes was significantly wider in the main group. Affective disorders, such as personal and situational anxiety according to the Spielberger-Hanin scale, as well as depression according to the Beck scale and depressive disorder according to the Hamilton scale, were more typical for patients in the main group. In patients of the main group, severe personal situational anxiety, severe and moderate depression according to the Beck scale, and depressive disorder of moderate severity according to the Hamilton scale prevail. Patients in the comparison group were more likely to have mild personal and situational anxiety, mild depression according to the Beck scale, and mild depressive disorder according to the Hamilton scale. Patients in the control group had mild situational and trait anxiety, and only a small number of patients had mild depression.
CONCLUSION
Patients with FBSS have less severe pain and less pain-related disability than patients with discogenic radiculopathy. In patients with FBSS, in contrast to the comparison and control groups, severe central sensitization, the frequency of occurrence of comorbid pain syndromes, high personal and situational anxiety, as well as severe depression predominate. Autonomic changes, manifested mainly in the form of sympathicotonia and parasympathicotonia, are also more common in the main group, which suggests the significance of these non-surgical factors in maintaining chronic pain in patients with FBSS.
