Persistent spinal pain syndrome

Persistent spinal pain syndrome (PSPS) is a pain disorder characterized by chronic pain originating in the spine. PSPS is categorized into two primary types:

• Type 1 (PSPS-T1): Spinal pain in patients who have not undergone surgery.
• Type 2 (PSPS-T2): Spinal pain following one or more surgeries.

PSPS type 2 replaces the older term failed back surgery syndrome (FBSS), which is now considered medically inadequate and potentially pejorative. While 'post-laminectomy syndrome' is still used by some clinicians, PSPS is the preferred label under ICD-11. Many factors can contribute to the onset or development of FBSS, including residual or recurrent spinal disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hypermobility with instability, scar tissue (fibrosis), depression, anxiety, sleeplessness, spinal muscular deconditioning, and Cutibacterium acnes infection. An individual may be predisposed to the development of FBSS by comorbid systemic diseases, including diabetes, autoimmune diseases, and peripheral vascular disease.