FAILED BACK SURGERY SYNDROME
Failed back surgery syndrome is a title used to describe the condition of patients who have had spine surgery that failed to manage their neck or back pain. Symptoms occur when the problem has not been relieved, or other more significant problems arise and cause continuing or worsening pain. FBSS is a chronic pain syndrome and results in physical disability as well as emotional and financial consequences for the patient.
Causes of FBSS
There are numerous factors that contribute to failed back surgery syndrome, including:
Failure to accurately identify conditions
- When surgery is performed at the wrong level of the spine or otherwise improperly.
- Surgeons inexperienced with spinal disorders may not make an accurate diagnosis— especially since the location of the patient’s pain is not always an indicator of the location or locations where the patient needs surgery.
- Nerve roots in the spine, when compressed, can lead to symptoms in distant areas of the body.
- Other conditions such as osteoarthritis can produce symptoms incorrectly attributed to conditions that require surgery.
Failure to adequately decompress a nerve root
- If the treating surgery commits a technical error like leaving behind bone garments or herniated disc material that presses on a nerve root causes pain that continues or worsens after surgery.
Spinal fusion failure
- Vertebral fusion usually takes place as part of the healing process after spine surgery. It takes up to several months to achieve a solid fusion after the surgeon removes a damaged disc and stabilizes the vertebrae with bone grafts or implants. In some patients, it never fully occurs.
- Sometimes an implant will shift out of its intended placement by the surgeon. These migrations occur during recovery before the implants can attach firmly to the vertebrae. If a displaced implant compresses neural tissue, it could create painful new spine conditions.
Scar tissue formation
- The body forms bands of scar tissue following any surgery. These bands can potentially bind a nerve root. This condition is called epidural fibrosis. It can lead to post-operative pain and failed back surgery syndrome.
decompressing a nerve root during spine surgery causes temporary inflammation. Usually, the inflammation subsides but in some cases nerve damage can occur, leading to chronic pain and weakness in certain muscle groups.
Symptoms of FBSS
Everyone heals differently. Discomfort during the healing process is normal. Some symptoms are indicative of a more serious problem. Persistent chronic pain that is not associated with healing processes are:
-New pain at a different level from the treated location
-Inability to recuperate
-Sharp, stabbing back pain
-Numbness or pain radiating to the lower back and into legs
-Anxiety, depression, and sleeplessness
-Dependence on drugs for pain treatment
Treatment of FBSS
Physicians will review treatment history and how your symptoms evolved following the surgery. They will perform a physical examination, and some form of imaging like an X-ray, MRI, or CT scan.
Conservative treatments like pain medication, injections, physical therapy, and exercise are recommended to relieve your chronic postoperative symptoms. If the pain is coming from facet or sacroiliac joints, chiropractic care may be recommended. If there are correctable structural problems, additional surgery may be performed to address issues brought on by failed back surgery syndrome. Sometimes no correctable cause for FBSS can be identified. In these cases, spinal cord stimulation or narcotic pumps may be used for pain control.
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