FAQ’s on Failed Back Surgery Syndrome (FBSS)
Failed back syndrome (or post-laminectomy) is said to occur when a patient continues to suffer from persistent lumbar pain following a surgical spinal procedure that was designed to provide relief (Failed back surgery syndrome 2011.). Failed back surgery syndrome (FBSS) is characterized by the presence of chronic symptoms after a treatment failed to provide a therapeutic effect, with patients commonly experiencing levels of symptoms that are similar to the symptoms experienced prior to surgery. It is also possible for symptoms to increase after surgery, resulting on symptoms of a much higher severity.
- Recurrent disc herniation
- Altered joint mobility or instable hypermobility
- Continued or persistent pressure on a spinal nerve
- Scar tissue or spinal muscular deconditioning
- Neurological effects such as depression, anxiousness, or insomnia
The USA and Holland have the highest number of cases of spinal surgeries with an increase of 22% in spinal fusions since 1990, and therefore the highest rates of FBSS. Patients who have had a failed back surgery are at risk of not being able to perform their desired levels of daily activity due to chronic pain. Patients experiencing symptomatic pains following surgery should contact one of our physicians immediately for consultation.
What are the causes of Failed Back Surgery Syndrome?
FBSS is higher in disc excision procedures as they leave up to 40% of the disc intact. A damaged disc, which can be a herniated disc or a bulging disc, can remove an important aspect of support from the spine and may cause spinal vertebrae to grind against each other during regular movement (Lumbar disc herniation and surgical management.2010). Whether directly due to the damaged disc, or due to the secondary effects a damaged disc can cause, patients with affected discs may experience severe pain even if the original therapeutic surgery was successful.
One of the other leading causes, even though it is a rare occurrence, is for procedural error to occur during the surgery or an incomplete operation, such as with lumbar stenosis. Procedural error can lead to only a partial reduction in pain, or may provide no relief at all. It is also possible for the attending to physician to improperly identify a patient as a surgical candidate, drastically reducing their chances of having a successful therapeutic surgery to begin with.
What are the symptoms of Failed Back Surgery Syndrome?
The most common symptoms of FBSS, or post-laminectomy syndrome, are a dull prominent pain in the back or sharp burn pains in the extremities. The primary symptoms a patient will experience will differ according to which spinal procedure was originally performed. In many cases, symptoms will be similar to the symptoms that were experienced prior to surgery.
Patients may experience procedural specific symptoms, which include a transference of pain to a different area of the spine in the event a spinal surgery does not work fully, or may experience pain if a separate level of the spine degenerates (such as if a patient undergoes spinal fusion and the next level of the spine develops similar complications).
Patients receiving a spinal disc decompression to provide relief for a compressed or pinched nerve may not obtain the desired relief. In some cases, if the nerve is decompressed improperly, pain may fade for a short while only to return at a later date. Some patients may develop a reoccurring formation of scar tissue, which can grow to encompass the nerve and produce symptoms similar to what were felt prior to surgery.
How is Failed Back Surgery diagnosed?
The diagnosis of failed back surgery can be difficult to achieve. In many cases, the same diagnostic efforts that were originally made for the patient will be repeated to see if the original source of pain has re-occurred. This is the quickest means of investigating whether or not the original cause is the current source of pain, or if there is a new one (such as scar tissue).
What are the treatment options for Failed Back Surgery?
The options available to patients will be based on which symptoms are present and to which severity they are being experience. Conservative treatments for failed back surgery syndrome include prescription medication for pain, physical therapy, therapeutic injections to suppress symptoms, or a secondary surgery to correct the first.
- TENS Transcutaneous electrical nerve stimulation
- Behavioral medicine or antidepressants
- Epidural lysis (adhesions) (Epidural lysis of adhesions for failedbacksurgery and spinal stenosis: factors associated with treatment outcome. 2014)
- Intrathecal morphine pump
- Membrane stabilizers
- Ozone treatment ( Effects of ozone applied by spinal endoscopy in patients with chronic pain related to failed back surgery syndrome: a pilot study.2013)
- Epidural steroid injections (Adjuvant hyaluronidase to epidural steroid improves the quality of analgesia in failed back surgery syndrome: a prospective randomized clinical trial. 2014)
- Neuromodulation (Rehabilitation perspectives of neuromodulation.2014)
One potentially effective tool in patients with chronic low back pain following a failed back surgery is the implantation of a spinal cord stimulator (Spinal cord stimulation for predominant low back pain in failed back surgery syndrome: study protocol for an international multicenter randomized controlled trial (PROMISE study).2013) to directly manage symptoms, a method that is currently being tested in a clinical setting (Spinal cord stimulation for predominant low back pain in failed back surgery syndrome,2013).