03 Feb Failed Back Surgery Syndrome
Failed back surgery syndrome (FBSS) is a generalized term used to describe a back condition that occurs due to spine surgery of the neck or back. The term applies when the surgery does not alleviate the original problem, or it creates another issue more significant than the original condition that required surgery. Experts estimate that 40% of patients undergoing traditional back surgery experience failed back surgery syndrome.
Based on studies by the U.S. National Institutes of Health (NIH), the likelihood of FBSS increases with the invasiveness of the surgery performed. The incidence depends on many factors, such as having open spinal fusion, having lower (lumbar) region surgery, and having serious pain before the procedure. Contributing factors include pressure on the spinal nerve, scar tissue around or within the nerves, altered joint mobility, muscle de-conditioning, facet joint degeneration, and sacroiliac joint degeneration.
Symptoms of FBSS
If you have failed back surgery syndrome, you may experience certain symptoms of varying degrees of severity. The symptoms of FBSS include:
- Limited mobility
- Continued or new chronic pain
- Pain in the surgical region of the spine
- Spinal joint immobility
- Sharp, stabbing pain in the extremities
- Inability to recuperate
- Dull, aching pain in the legs, back, or neck
- Spinal joint immobility
- Muscle spasms
Identified Causes of Failed Back Surgery Syndrome
FBSS does not always develop due to spine surgery. However, there are some known causes, which include:
- Failure to identify the condition – Some surgeons are not experienced in diagnosing and treating FBSS. The underlying cause of a person’s neck or back pain may contribute to the development of FBSS.
- Failure to decompress nerve roots – A technical error by the treating surgeon could result in FBSS, such as leaving a tiny bone fragment or disc material along the spine. This causes nerve root compression, which results in worsening or continued back pain.
- Spinal fusion failure – Spinal fusion is used to relieve nerve compression by removing a portion of a damaged disc and stabilizing the adjacent vertebrae with implants or bone grafts. The pain varies from person-to-person and can affect the healing process.
- Implant migration – If an implant is surgically placed along the spine, it can affect the body’s healing process. An implant has moved out of its intended spot, and not be effective.
- Scar tissue formation – With natural healing processes, the body forms scar tissue around the surgical area. This tissue can turn fibrous, which bind to nerve roots. The pain of the fibrous may be worse than the pain before surgery.
- Nerve damage – Decompressing the nerve root may cause temporary inflammation, which also leads to increased pain. During surgery, a nerve can become damaged, and continue to produce nerve signals even though the original problem is solved.
Your Treatment Options
Failed back surgery syndrome can be treated using physical therapy, medications, injections, or nerve blocks. When the pain is associated with the facet joints, a facet joint injection can alleviate the pain. In some cases, spinal cord stimulation (SCS) is used. This involves inserting a tiny battery-powered device in the lower abdomen. Wires are threaded from the device to attach to tiny electrodes along the spine. The pleasant signals emitted will interfere with pains signal transmission to alleviate pain.
Treatment of failed back surgery syndrome often involves a combination of treatment options. The surgeon may recommend a repeat surgery, to alleviate nerve compression, or correct the underlying problem. Sometimes, scar tissue must be removed to alleviate the pain. However, for 10% of patients, the pain associated with FBSS is chronic, and it persists regardless of options.