Purpose: Low back pain continues to be a leading form of disability, with chronic pain post spinal surgery representing a significant contributor. Characterized as persistent spinal pain syndrome (PSPS) or failed back surgery syndrome (FBSS), ongoing postsurgical pain continues to be a significant clinical challenge due to its multifactorial etiology. Emerging evidence suggests pre- and post-operative inflammatory responses are critical in the development of FBSS. This literature review evaluates correlation between proinflammatory cytokines including interleukin- 1b (IL-1b), interleukin-6 (IL-6), and tumor necrosis factor- alpha (TNF-a), and development of chronic back pain.
Methods: A formal literature review using publications from PubMed/MEDLINE and Google Scholar was conducted to identify clinical studies evaluating proinflammatory cytokine levels and chronic pain outcomes post spinal fusion in adults. Inclusion criteria included peer-review articles published between 2015-2026 focusing on human clinical trials and longitudinal cohort studies. Titles and abstracts were screened, followed by full-text review. Findings were synthesized qualitatively due to heterogeneity in outcome measures and study design.
Results: Included studies supported the use of predominantly IL-6, preoperative and postoperative levels, for predicting the development of FBSS/PSPS. Higher intradiscal and systemic IL-6 levels were associated with greater postoperative back pain, disability, and poor recovery trajectories. Studies also identified TNF-a and IL-1b as predictors of the development of chronic pain. However, studies lacked consistent cytokine measurement timing as well as longitudinal data on the course of chronic postoperative pain.
Conclusion: IL-6, along with TNF-a and IL-1b, show promise as predictors of FBSS/PSPS across multiple clinical studies, showing consistent linkage to poor recovery trajectories. Due to limitations in cytokine measurement and available longitudinal data, a definitive correlation to proinflammatory cytokines cannot be made. However, future prospective studies should standardize cytokine measurement and provide long term data to establish if early modulation of inflammatory pathways can reduce the incidence of FBSS/PSPS.
Methods: A formal literature review using publications from PubMed/MEDLINE and Google Scholar was conducted to identify clinical studies evaluating proinflammatory cytokine levels and chronic pain outcomes post spinal fusion in adults. Inclusion criteria included peer-review articles published between 2015-2026 focusing on human clinical trials and longitudinal cohort studies. Titles and abstracts were screened, followed by full-text review. Findings were synthesized qualitatively due to heterogeneity in outcome measures and study design.
Results: Included studies supported the use of predominantly IL-6, preoperative and postoperative levels, for predicting the development of FBSS/PSPS. Higher intradiscal and systemic IL-6 levels were associated with greater postoperative back pain, disability, and poor recovery trajectories. Studies also identified TNF-a and IL-1b as predictors of the development of chronic pain. However, studies lacked consistent cytokine measurement timing as well as longitudinal data on the course of chronic postoperative pain.
Conclusion: IL-6, along with TNF-a and IL-1b, show promise as predictors of FBSS/PSPS across multiple clinical studies, showing consistent linkage to poor recovery trajectories. Due to limitations in cytokine measurement and available longitudinal data, a definitive correlation to proinflammatory cytokines cannot be made. However, future prospective studies should standardize cytokine measurement and provide long term data to establish if early modulation of inflammatory pathways can reduce the incidence of FBSS/PSPS.