Pathogenesis of failed back syndrome

including personal opinion of epiduroscopy

Abstract

For diagnosis of failed back syndrome (FBS), we should consider the following three points; 1) possibility of change in the pathogenesis, 2) limitations of imaging (x-ray, CT, MRI, etc) and 3) psychosomatic problems. Regarding pathogenesis, FBS is divided into three groups; 1) organic pain possible to treat by surgery, 2) organic pain impossible to treat by surgery and 3) subjective symptoms mainly affected by psychosomatic problems. Epiduroscopy may be useful to treat some kinds of FBS, especially that caused by epidural inflammation and adhesion. There are many unresolved issues regarding treatment using epiduroscopy, such as the mechanisms of therapeutic effects and clinical evidence of the outcome, however, epiduroscopy may have some value and is expected to develop further in the future.