FAQ’s on Failed Back Surgery
What is Failed Back Surgery?
Failed back surgery syndrome (FBSS) occurs when patients are still experiencing persistent pain after undergoing back surgery. It is a condition characterized by the presence of chronic pain even after patients have sought treatment, commonly occurring when the treatment did not obtain the desire therapeutic effect. Patients will normally feel levels of pain very similar to those felt pre-surgery, but may also feel pain that is worse than the symptoms they had prior to surgery in their back and/or legs.
Patients experiencing failed back surgery may not be able to perform their desired daily activities fully due to re-occurring pain, and are encouraged to seek consultation by a physician to obtain true relief. The United States and Holland have the highest amount of failed back surgeries, as they have the highest amount of spinal surgery (Low back pain hospitalization. Recent United States trends and regional variations 2004).
What are the causes of Failed Back Surgery?
One of the largest causes of recurrent pain in a failed back surgery is the formation of a disc herniation following surgery. Disc herniation occurs when one of the inter-vertebral discs is damaged, causing it to lose internal disc fluid and no longer be able to provide proper support to the spine. Herniation of a disc can produce sudden onset pain even after relief was present following surgery.
A second common cause of failed back surgery is procedural error occurring during the surgery. While extremely rare, it is still possible for a mishap to occur mid-procedure that results in only partial pain relief or in no relief at all. Inappropriate preoperative selection of patients may also be a contributing factor to the failure rate of specific spinal surgeries.
What are the symptoms of Failed Back Surgery?
The symptoms a patient will experience will vary based on what the original spinal procedure they underwent was. In many cases, the symptoms present will be similar to the symptoms felt prior to the surgery. Procedural specific symptoms include transference of pain to a different level of the spine if a spinal implant does not take, or if a different level of the spine degenerates following spinal fusion.
Patients undergoing decompression surgery due to nerve damage may not obtain relief, and preoperative pain may not fade. Failure to properly decompress a nerve may also cause pain to return after a short duration of time. It is also possible for the scar tissue surrounding the nerve to re-form following surgery, leading to a second occurrence of symptomatic pains. If scar tissue compresses the nerve, patients may experience secondary effects in the limbs once again.
How is Failed Back Surgery diagnosed?
The diagnosis of failed back surgery can be a complicated thing to achieve. The first step in diagnosis of a failed surgery is to repeat the diagnostic efforts made that identified the original cause of symptomatic pain. This can be the quickest means of investigating to see if the original cause of pain is the current pain, or pain is resulting from a new factor such as scar tissue.
If the original diagnostic efforts were poor, it is possible that the surgery has failed due to something other than the root cause of pain being the focus of surgery. A common example is when a patient is experiencing pain due to a lesion, and the attending surgeon fails to remove the correct lesion. Accurate diagnosis of the patient is the most crucial step in both preventing and in treating failed back surgery.
What are the treatment options for Failed Back Surgery?
The available options will depend on the severity of pain and on what the cause of pain is identified as. Common treatments include prescription oral medication for pain, epidural therapeutic injections designed to suppress pain for an extended period of time, or secondary surgery.
Treatment options for FBSS or post-laminectomy syndrome may include:
- Pt Physical therapy
- Microcurrent electrical neuromuscular stimulation
- TENS therapy