25.1 Introduction

PFS is defined as persistent back pain after vertebral augmentation or other posture altering spine injury that worsens with upright posture and increased time standing and is relieved when sitting or lying recumbent. This syndrome most commonly affects the mid-thoracic and thoracolumbar junction regions. Being able to recognize this syndrome is extremely important for postprocedural patient care. Patients will present on follow-up with residual back pain that is not as severe as before the vertebral augmentation procedure but still bothersome to the patient. The characteristics of the pain are also different from VCF pain that worsens with patient movement and transition from one position to another. A lack of awareness of PFS can lead to misdiagnosing this syndrome and physicians labeling an otherwise well-performed vertebral augmentation as a “failed” intervention. More importantly, PFS was not diagnosed nor mentioned in three controversial randomized controlled trials. ^{1 – 3} The lack of assessment of this syndrome was a likely contributor to the absence of statistical superiority of the vertebroplasty arm in comparison to the sham group. Given the precarious statistical balance of the sham and vertebroplasty arms, it is possible that if this syndrome had been taken into consideration in those studies, different outcomes would have been published. This pathology can be easily and affectively treated by medial branch blocks, and most patients will do very well after a single medial branch block treatment. Even without treatment the pain typically decreases substantially within 6 to 10 months following vertebral augmentation.