Failed Back Surgery Syndrome
Failed back surgery syndrome (FBSS) is a condition where a patient has back surgery that is not successful in relieving pain. This condition results in persistent pain for patients who have undergone major neck or back surgery.
After a spinal fusion, the body normally adjust to the presence of plastic or metal implants, but sometimes, postoperative pain persists. Published reports estimate the incidence of FBSS to be around 30%, with the chance greater for those patients who have a repeated surgery.
What are the symptoms of failed back surgery syndrome?
The most obvious symptom of FBSS is persistent chronic pain that is not related to the healing process. Other symptoms associated with this are restricted mobility, inability to recuperate, new pain at another location, back spasms, numbness that radiates down the legs, anxiety, depression, and sleeplessness.
What are the reasons for failed back surgery syndrome?
Spine surgery is done to stabilize a painful joint or to decompress a nerve root that is pinched. Unfortunately for some patients, back surgery does not stop all spine pain. The main reason some patients have pain after back surgery is not effective is that the lesion operated on may not be the cause of the pain. Also, some back pain persists even after surgery, as other areas of the spine develop problems.
What back surgeries result in FBSS?
A discectomy for a herniated lumbar disc is not always successful in alleviating pain. In addition, a spine fusion for spondylolisthesis (spine instability) is done for multi-level degenerative disc disease, and often is not successful for reducing a patient’s pain following the procedure.
What is the cause of continued back pain after spinal surgery?
There are several possible causes of pain following a spine surgery. These include:
- Lumbar decompression back issues – This includes spinal stenosis, disc herniation, preoperative nerve damage, inadequate decompression of a nerve root, and persistent nerve damage.
- Fusion surgery considerations – This includes failure to fuse or implant failure, as well as a transfer lesion to another area after the fusion.
- Scar tissue development – This includes epidural fibrosis, where there is scar tissue formation around a nerve root.
- Postoperative rehabilitation – This involves continued pain from a secondary cause.
- Implant failure in surgery – Metal hardware failure can occur in spinal fusion surgery. Large patients who have many fusions often have implant failure.
How does the doctor diagnose FBSS?
If pain is persistent after spine surgery, the doctor will order tests, such as x-rays, MRIs, and CT scans. Also, he will conduct a detailed medical history and physical examination.
What is the treatment for failed back surgery syndrome?
The goal of therapy for FBSS is to relieve pain and to correct any structural problems. Treatment includes:
- Physical therapy – This is used after back surgery to teach strengthening and stretching exercises.
- Neurostimulation – The stimulator is an implanted device that transmits electrical signals to the nerves to block pain.
- Intrathecal medication pump – This unit is prescribed for patients with severe pain. The device delivers medication directly to the point of pain.
- Medications – Commonly prescribed medications include NSAIDs, nerve blocks, antidepressants, and membrane stabilizers.
- Corrective surgery – When the doctor can determine the source of failed back surgery pain, he can perform another operation to fix the problem. This is called corrective surgery.