Failed back surgery syndrome
What is failed back surgery syndrome?
Failed back surgery syndrome (FBSS) is actually a misnomer, as it is not really a “syndrome”, but a very generalised term that is often used to describe the condition of patients who have had unsatisfactory results from back or spinal surgery and have experienced continued or chronic and persistent pain after the operation. Sometimes these are patients who have undergone a wide variety of spinal surgeries with unsatisfactory results.
What are the causes of failed back syndrome?
The causes of failed back syndrome are many: there are many reasons why a back operation may not work, even with the best surgeon and the best indication.
Back or spinal surgery is only able to treat the anatomical lesion (injury) that is a probable cause of back pain, which should be identified before and not after surgery. Proper diagnosis and patient selection is key.
By far the main reason why back operations are not effective and some patients continue to suffer pain after surgery is that the operated lesion is not the cause of the patient’s pain.
However, there is no single reason why a back operation is unsuccessful, so there is no specific treatment. At BSI we are expert spine surgeons and can assess your case on a personalised basis and advise you on the best treatment options to help you improve your symptoms.
The causes of failed back syndrome can be summarised as follows:
- Fibrosis of the spinal canal. After any operation on the spine, it is normal for scarring to occur. As a result, the wound closes, forming the superficial scar that we see on the skin. But, in addition, this same scar also extends deep down, affecting the muscles, fat and bone. Everyone heals differently, and the problem occurs when the scarring is excessive. This is what happens in spinal canal fibrosis, in which the scar grows excessively and adheres to the nerves, causing persistent chronic pain.
- Instability of the spine. In this case, there is excessive movement of the vertebrae, which can trap the spinal cord or nerves. This can occur because bone tissue has been removed in the previous surgery, or the ligaments securing the spine have been damaged, or because bone fusion has not occurred properly or the instrumentation in place has not fused properly (pseudarthrosis).
- Inadequate patient selection for surgery. Proper patient selection prior to spine surgery is critical to ensure good outcomes, minimise risks and complications, and ensure that the patient is properly informed and prepared for the recovery process. Each patient is unique in terms of their medical condition, medical history, age, activity level, and expectations.
Some patients may have pre-existing medical conditions, such as cardiovascular disease or diabetes, that increase the risk of complications during or after surgery. Identifying these risk factors and optimising the patient’s health prior to surgery can reduce postoperative complications and improve long-term outcomes.
Therefore, it is essential to thoroughly evaluate each patient to determine whether surgery is the right option and which surgical technique is most appropriate for their particular case. - Disc herniation recurrence. A disc herniation recurrence is when a previously treated disc herniation recurs after surgery. The likelihood of recurrence varies, but statistically ranges from 15% to 20%.
How is failed back syndrome diagnosed?
Each case of failed spinal surgery will require a personalised diagnosis. To do this, your specialist will perform a physical examination, evaluate the symptoms and request diagnostic tests, usually magnetic resonance imaging, X-rays (sometimes dynamic or functional), CT scans and also neurophysiological studies (electromyogram, evoked potentials, etc.) to assess the functioning of the nerves and determine which nerves are most affected.
Your specialist will also study and review in detail the previous surgery/s that have been performed and any possible complications that may have arisen.
What is the treatment for failed back syndrome?
Once you have obtained clear diagnostic guidance on failed back syndrome, your surgeon will make a treatment proposal aimed at the specific cause of the pain.
The treatments for failed back syndrome can be conservative measures with analgesia and physiotherapy, or infiltration of the vertebrae or nerves (such as neurolysis or rhizolysis/radiofrequency).
In certain cases (spinal instability, pseudarthrosis, nerve compression, etc.), further surgery may be indicated. In these cases, a dialogue with your surgeon will always be very important in which expectations of the surgery, risks/benefits, are properly adjusted.
Failed back surgery syndrome is complex to treat and each case will require a personalized assessment and a comprehensive and probably multidisciplinary evaluation and approach to address the various contributing factors. Our specialists at BSI – Spine Institute will be able to advise you and help you find the best option for your case.