Failed back surgery syndrome, (FBSS) is a term referring to the chronic and severe pain a patient can experience after unsuccessful surgery. FBSS affects up to 40 percent of patients who have had traditional open back or minimally invasive spine surgery. Often surgery is indicated for an identifiable source of pain due to pinched nerve root or an unstable and painful joint. However, back pain can have many causes and accurate identification of the source of pain is complicated. Too often an x-ray and Magnetic resonance imaging (MRI) scans does not correlate well with symptoms. Therefore, diagnostic injections are often warranted and assist in making the proper patient selection and spinal level for surgery.
- Inaccurate diagnose of the condition(s)
- Failure resulting from spine fusion
- Lateral recess stenosis
Failure to decompress the area between the midline and lateral aspect of the exiting nerve - Surgery performed at the wrong level of the spine
- Adjacent segment disease
The development of pain, instability of degenerative conditions at the level above of below the previous surgical site. - Scar tissue formation
- Missed disc fragment, re-herniation of disc or bone spurs still pinching the spinal nerve
- Nerve damage from surgery
What are the symptoms of Failed Back Surgery Syndrome?
The pain associated with failed back syndrome varies depending on the surgical procedure performed and the conditions treated. The pain can range from a dull ache to sharp stabbing pain and may be localized to one area of the back or reach into the legs. Patients suffering from FBSS can experience any of the following symptoms:
- Chronic pain
- Pain at the adjacent area above or below the previous treated area
- Decrease Mobility
- Aching and dull pain in the back, legs or neck
- Sharp or stabbing pain
- Spasms
- Increase dependence of pain medicine
- Medical history
Assessment of symptoms, previous treatments and care. - Physical examination
A careful examination by a spine specialist for limitations of movement, problems with balance, and pain. The examination should also cover loss of reflexes in your extremities, muscle weakness, loss of sensation or signs of spinal cord damage. - Diagnostic tests
Generally, plain x-ray films are taken which allows the physician to rule out other problems such as infections. CT scans and MRIs are often used to give them a three-dimensional view of the lumbar spine and can help detect herniated discs.
What Are The Treatment Options For Failed Back Surgery Syndrome?
Treatment of failed back surgery syndrome and chronic pain is difficult. In order to accurately diagnose FBSS a complete history and symptoms the patient is experiencing. It is also important to get a new MRI or CT Scan and do diagnostic injections to better understand what is causing the pain and pinpoint the affected area.
Surgical Treatment
Once conservative measures have been exhausted and the patient is still in considerable pain after 6 months then minimally invasive procedures may be recommended. The following procedure has shown great results in alleviating pain altogether and returning patients to work and life sooner than traditional spine surgery.
- Transforaminal Endoscopic Discectomy
Treats herniated, bulging, protruded, and extruded discs. Under direct visualization the physician uses the endoscope to decompress the disc to relieve the pressure on the affected spinal nerve. - Endoscopic Foraminalplasty
Treats degenerative disc, foraminal stenosis and facet disease. As the space between the facets diminishes the foramen (natural opening for the spinal and exiting nerves) becomes narrow and begins to compress the nerves. The endoscopic technique uses ronguers, reamers and small motorized burrs to selectively take some bone in order to enlarge the foramen thus decompressing the nerves freeing them up. - Endoscopic Rhizotomy
Patients who have received some temporary relief from percutaneous medial branch rhizotomy but the pain came back are good candidates for endoscopic rhizotomy. This procedure allows the physician to place a small cannula and endoscope inside the patients back and target visually the medial branch nerve. A radiofrequency probe is used through the endoscope to ablate the medial branch nerve. The results of an endoscopic rhizotomy have been significantly better long-term than traditional percutaneous rhizotomy. - Microdiscectomy
Usually an open procedure or using tubular retractor with an incision of 1 inch. The surgeon usually observes through a microscope or set of eyeglass loops that helps magnify the anatomy. Recovery can be long and painful. Most of the pain post-operative is from the approach the surgeon made through major muscle support in your back. Anesthesia is necessary. - Minimally Invasive Discectomy and Fusion
The surgery involves removing the damaged intervertebral disc and replace it with a piece of bone or PEEK cage packed with bone to assist in union or fusion of the two vertebral bodies over time.
Most minimally-invasive patients can begin getting out of bed hours after surgery and go home shortly afterward. With a MIS spine fusion, the time for post-operative recovery is longer and may involve overnight stay in the hospital. Activity is gradually increased and patients are typically able to return to work within a few days to 2 weeks depending on the type of surgery and job description. With a spine fusion return to work may be up to 4-8 weeks. There will probably be some pain after the procedure and is usually localized to the incision site. However, just because there is less or no pain, always consult your physician before beginning any physical work.
At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a couple of days after surgery. The doctor will discuss with you other techniques for reducing pain and increasing flexibility before you leave for home. The doctor will also discuss with you a time frame for when you can resume basic activities such as walking, driving and light lifting, and when you can return to more advanced activities such as physical labor, sports and yard work.