FAQ’s on Failed Back Surgery Syndrome

What is failed back surgery syndrome?

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Failed back surgery Syndrome (FBSS) is not, contrary to its name, a syndrome: it is a
catchall term describing the condition of continued pain after back surgery. The presentation is usually chronic, and patients who suffer from the condition often report persistent pain of the back and/or the legs, following surgery. There may be symptoms of neuropathy (problems with the nervous system) such as tingling, numbness, or shooting pain. This condition has also been described as the “post-laminectomy syndrome”, since it has been noted to occur after this procedure.

What are the causes of failed back surgery syndrome?

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There are a wide variety of causes for failed back surgery syndrome, and the physician will need to do a complete medical history, and physical examination to determine the underlying pathology. Additional imaging studies may also be requested, such as X-rays, Computerized Tomography (CT) scans, and Magnetic Resonance Imaging (MRI) scans.

Surgical operations of the spine to alleviate back pain can either (a) stabilize a painful joint or (b) decompress a nerve root that has been “pinched”. However, not all surgical operations are successful. Reasons for the failure of surgery can include:

  • Improper patient selection – the most commonly identified reason for FBSS is because the lesion/area that was operated on is revealed not to be the (anatomic) cause of the patient’s pain. For example, a patient that is treated for pain that is suspected to be secondary to a degenerative spinal condition may in fact be suffering from other conditions that mimic back pathologies.
  • Recurrent disc herniation – This presents as initial relief of pain symptoms, which is only temporary. Sudden acute pain differentiates this condition from pain from epidural fibrosis (scar tissue), wherein the symptoms develop over a longer period.
  • Surgical errors – technical errors during surgery should also be considered as a possible source of the pain. There may be fragments of bone or disc remaining, or there may have been another disc causing the pain. Some studies have shown that physicians may overlook conditions such as sacroiliac joint disease.
  • Spinal stenosis – this refers to the narrowing of the canal for the nerve roots. This has been observed as a late complication of laminectomy for disc herniation.

It should be noted that cigarette smoking has been shown in recent studies to contribute to the failure of spinal surgery. It is theorized that substances from cigarettes interfere with bone healing and growth, and some surgeons consider smoking an absolute contraindication to surgery.

How is failed back surgery syndrome treated?

Failed Back Surgery Treatment San DiegoThe exact treatment of failed back pain syndrome will depend on the identified underlying pathology. Treatment options include:

  • Conservative management – this includes non-surgical interventions, such as medications, psychological counseling, physical therapy, complementary alternative medicine, such as acupuncture, among others.
  • Spinal cord stimulation – this therapy has been proven to be effective, albeit not cost effective for some patient.
  • Nerve blocks – treatment with injections of corticosteroids (powerful anti-inflammatory drugs) have been shown to be effective in relieving symptoms of pain. Other novel treatments have been explored in recent years, such as adjuvant injection of hyaluronidase.
  • Ozone therapy – the application of ozone therapy applied by spinal endoscopy has been shown in pilot studies to provide up to 60% reduction in pain, although the effectiveness is limited to certain conditions.
  • Repeat surgery – if the pain is due to errors in surgery, a follow-up/repeat operation may be warranted.

The outcomes of treatment for FBSS are varied. They depend on the specific circumstances of the case. The best intervention for FBSS is still prevention.

References

Chan CW, Peng P. Failed back surgery syndrome. Pain Med. 2011 Apr;12(4):577-606. doi: 10.1111/j.1526-4637.2011.01089.x.

Hussain A, Erdek M. Interventional pain management for failed back surgery syndrome. Pain Pract. 2014 Jan;14(1):64-78. doi: 10.1111/papr.12035.

de Nêuton F, Magalhães O, Soares SC, Torres JM, Ungaretti A, Cacciacarro MF, Teixeira MJ, Fonoff ET. Effects of ozone applied by spinal endoscopy in patients with chronic pain related to failed back surgery syndrome: a pilot study. Neuropsychiatr Dis Treat. 2013;9:1759-66. doi: 10.2147/NDT.S48663.

Reverberi C, Dario A, Barolat G. Spinal cord stimulation (SCS) in conjunction with peripheral nerve field stimulation (PNfS) for the treatment of complex pain in failed back surgery syndrome (FBSS). Neuromodulation. 2013 Jan-Feb;16(1):78-82; discussion 83. doi: 10.1111/j.1525-1403.2012.00497.x.