Spinal fusion surgery - the need to follow the ‘BRAN’ toolkit (benefits, risks, alternatives, nothing): a case report

Failed back surgery syndrome is defined as increased or persistent pain following spinal surgery. Despite a relatively high incidence of failed back surgery syndrome (20%), patients may not be counselled regarding this complication pre-operatively. The Academy of Medical Royal Colleges has provided the Benefits, Risks, Alternatives and doing Nothing Toolkit to guide clinical discussions during the consent process. A 46-year-old female experiencing chronic lower back pain since 2003 suffered an exacerbation in 2015. Imaging identified non-compressive disc bulges. She was not put through the low back pain pathway as recommended by NICE and underwent spinal fusion in 2017. She continues to experience severe pain 54 months postsurgery. When considering spinal surgery, the risk of failed back surgery syndrome should be discussed with patients. Both clinicians and patients can use the BRAN toolkit to ensure open and transparent discussion prior to any intervention.