Failed Back Surgery Syndrome Fbss
The term Failed Back Surgery Syndrome is a misnomer; it is actually a general term applied to any unsuccessful back surgery that leaves the patient in continued pain, or exacerbates their pain levels.
Although the term is often applied in description of the symptoms of a patient following unsuccessful back surgery, it is not actually a condition unto itself. If used in relation to a specific procedure, for example a laminectomy, FBSS would be referred to as post-laminectomy syndrome.
The term is applied when a back surgery fails to accomplish its intended goal or actually makes the patient’s condition worse. It is not well known that 10% of back surgeries actually leave patients worse than they were pre-operatively, and 25-40% of patients are unhappy with their back surgery outcomes at the two year point.
No other surgical procedure has an equivalent term, as in, there is no such thing as “failed appendectomy syndrome” or “failed root canal syndrome”. The reason for this term is that back surgery has several reasons a procedure may be unsuccessful.
With the number of patients receiving surgical procedures of the spine due to chronic pain annually being relatively high, (over 500,000 disc procedures alone) many persons experience FBSS.
Who is at risk for FBSS? Collapse
With many surgical procedures of the spine being unsuccessful, anyone who undergoes a spinal surgery is at risk of suffering from FBSS. FBSS typically occurs from one of 4 situations:
- Surgery being performed for the wrong reason.
- Surgery done for the right reason and technically done well – at times back surgery just doesn’t work as well as hoped.
- Surgery done for the right reason and either it was done with technical errors or the patient simply did not fuse properly.
- Surgery went well, patient obtained excellent pain relief initially. Then later scar tissue envelops nerve roots leading to pain, or adjacent segment breakdown occurs leading to pain.
What symptoms are associated with FBSS? Expand
Patients having undergone a spinal surgery who find (after appropriate healing time has passed) that the procedure was ineffective in relieving chronic pain or has exacerbated their pain levels are likely experiencing FBSS.
Common symptoms associated with FBSS that are experienced often mirror pre-surgery symptoms and may include pain in the back or legs, and sharp, stabbing pain felt throughout the extremities.
What treatment options are available for persons suffering with FBSS? Expand
Treatments for FBSS include treatments identical to pre-surgical chronic pain:
- Physical therapy: strengthening training and stretching exercises is often beneficial.
- Minor nerve blocks to numb nerves associated with the patient’s pain.
- Microcurrent electrical neuromuscular stimulator
- Non-steroidal anti-inflammatory (NSAID) medications
- Transcutaneous electrical nerve stimulation (TENS)
- Membrane stabilizers
- Spinal cord stimulation: this interrupts the pain signals to the brain to help relieve pain.
- Intrathecal morphine pump: this supplies a steady dose of pain medication.
- Epidural steroid injections: these numb the nerves associated with the pain.
- Facet injections for painful adjacent segments.
As a complete last resort, the spinal cord stimulator implant can help mask pain. However, it does not fix the problem. If further surgery is not indicated and the problem cannot be “fixed”, the implant can be exceptionally helpful for relief of both back and leg pain.
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