Failed back syndrome:
Failed back syndrome (FBS), also called failed back surgery syndrome (FBSS), is a generalized term used to describe patients who continue to have back pain after surgery. That pain may be worse than before surgery, the same as before surgery, or may have continued pain after surgery, even if it is at a lower level.
What causes failed back syndrome?
Spine surgery essentially does one of two things
- decompress a nerve or the spinal cord
- stabilizes a painful segment of the spine
Spine surgery is not able to cure the pain, as in make the pain go away. It changes the anatomy of the spine and changing the anatomy decreases the pain. Pain continues after spine surgery for one of the following reasons:
- Misdiagnosis and operating for a wrong diagnosis
- Doing a surgery that usually has great results for one type of disease presentation and attempting to do that surgery for a condition that is questionable. For example, low back pain that is causing leg pain via a herniated disc is able to be treated with microdiscectomy. Doing a microdiscectomy while having only localized back pain without radiating leg pain may not necessarily remove all the pain.
- Implant failure: if the plates and rods fail to fuse into the bone, it may cause pain and irritation necessitating a revision surgery.
- Failure of fusion: If your bones fail to fuse after surgery, then this may be a pain generator and require additional surgery to revise the failed fusion.
- Scar tissue formation: Scar tissue can develop after spine surgery which may cause continual irritation to the nerve roots.
- Nerve damage: If a nerve is inadvertently injured during surgery, this may lead to continued pain in the back or legs. This sometimes requires additional surgery.
- Inadequate decompression: If a nerve is pinched or the spinal cord is compressed, not removing enough bone or compressive tissue may lead to continued pain and/or weakness requiring additional surgery.
- Adjacent segment disease: When fusing two segments of the spine, there is increased stress applied to the segments above or below the fusion. For example, if levels L4-L5 are fused, the L3-4 level (above the fusion) and L5-S1 level (below the fusion) may degenerate faster, causing pain.
What are the symptoms of failed back syndrome?
For those who have continued pain after back surgery, some of the common complaints are:
- Continued pain in the same location as prior to the surgery
- Muscle spasms as the muscle may be irritated after the surgery
- Electric pain in the arms, around the abdomen, in the groin, or down the legs
- Pain above or below the surgery location
- Lack of improvement over time
How does Dr. Webb treat failed back syndrome?
Failed back syndrome is not a specific diagnosis in the traditional sense. It mainly comes either after operating for the wrong diagnosis, operating on the wrong level, performing inadequate decompression, failure of the surgery itself, or not giving the body enough time to heal.
The best way to diagnose failed back syndrome is to obtain a history and perform a thorough physical exam. In addition, a review of your imaging studies may be helpful.
Each case of failed back syndrome is treated based on the patient, because there is no one-word answer that treats all cases.