Failed back surgery syndrome (FBSS) is the term used for continued pain a patient has after unsuccessful back surgery. The patient is usually referred to a pain management specialist to treat existing pain.
The goal of spinal surgery is to decompress a nerve root or to stabilize a painful joint. FBSS occurs when surgery is unsuccessful or when the surgery negatively affects a structure near the problem area.
Spinal surgery is complicated because it can be hard to diagnose the cause of the pain. X-Rays and MRIs limit what doctors can see because many times, the pain occurs when the patient is moving and active. Imaging only provides still images.
Signs & Symptoms of FBSS
One common complaint physicians hear from patients is chronic back pain. However, not everyone experiences the same pain, and the type of pain they experience can vary, based on their spinal disorder, their previous procedure, or underlying cause of FBSS.
Other types of pain that can be associated with FBSS are:
- Nociceptive Pain – Localized pain that may be dull or sharp.
- Neuropathic Pain – Nerve-related pain is caused by damage to the nerves or spinal cord.
- Radicular Pain – Radicular pain radiates from one area to another
Other common symptoms of Failed Back Surgery Syndrome include:
- Return of original symptoms & pain – When the symptoms return that the original procedure was intended to correct, it may be a sign of FBSS.
- Reduced mobility – Recovering from back surgery is a process. However, if mobility is reduced or limitations arise that are different than predicted by your physician, it could be a sign of FBSS.
- New problems arise – While the original symptoms may be corrected by the surgery, new pain in a different part of the spine should be discussed with your doctor.
- Onset of Headaches – If headaches were not a part of your medical history prior to having surgery, this may be a sign of nerve damage after a spinal procedure.
Diagnosing Failed Back Surgery Syndrome
The first step to diagnosing FBSS pain is to see a doctor for a physical exam. Motion, sensitivity, and strength help doctors decide the next steps to correctly diagnose the pain. Your medical history, pain levels, and previous treatments are discussed with your doctor to help them define the pain and decide on a treatment method.
Having tests like CT scans, MRIs, and X-Rays help doctors take an inside look at your pain. The images don’t always show the root cause of the pain, making FBSS hard to diagnose.
Since imaging is not always reliable, doctors may use another form of testing to diagnose your pain. This is called an aware state surgical examination. A doctor uses a small probe and stimulates the spinal cord, mimicking the pain, and triggering a response from the patient. This informs the doctor as to what type of pain the patient is having and how it is caused.
Back pain patients are referred to pain management specialists who treat their pain and help improve their quality of life through short-term techniques.
Conventional Treatments for Failed Back Surgery Syndrome
There are many conservative treatments for FBSS. Doctors use nerve root blocks and injections to treat the pain and can provide temporary relief for up to one year. Injections are used for different things. Some reduce scarring and others are steroid injections that reduce pain surrounding the spine.
These injections can negatively affect the lives of older patients by limiting their ability to work and lifestyle. Other treatments that are available include the placement of a spinal cord stimulator (STIM) that reroutes the pain away from the brain.
Non-Conventional Treatments for FBSS
Non-conventional treatments for failed back surgery syndrome are proven to be great alternatives to surgery for older patients since they avoid strong anesthetics.
Decompression surgery is a minimally invasive procedure that relieves pressure from the nerves of the spine. Spinal pressure can be caused by back injuries or herniated discs. The process removes scar tissue or bone spurs that affect the nerves causing pain.
Another procedure called Transforaminal Endoscopic Lumbar Decompression and Foraminoplasty (ELDF) lets the doctor gain access to the nerve root and “wake up” the nerve and remove the things causing pain. This allows the doctor to treat your pain with accuracy, with minimal damage to surrounding structures in the back. ELDF procedures offer longer-term pain relief.
If compression isn’t causing the pain, a doctor will insert a steroid or anesthetic into the disc to determine each symptom. This procedure can be used to see if the unsuccessful back surgery helped treat the pain.
Fusion surgery is similar to decompression in that the goal is to reduce pain. Instead of removing the damaged soft tissue, it fuses the bones together to give your back more stability using special hardware.
These alternative methods for treating failed back surgery syndrome have an 80% success rate and the results keep improving as the field of pain management continues to evolve and grow.