Failed Back Surgery Syndrome: Diagnosing & Treatment Options


April 19, 2019

Failed back surgery syndrome (FBSS) is the term used for continued pain a patient has after an 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.

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; however, 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 mimics the pain using a small probe to stimulate the spinal cord, which triggers 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. Some injections reduce scarring and others are steroid injections that reduce pain surrounding the spine.

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 can 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 (TELDF) lets the doctor gain access to thenerve root and “wake up” the nerve and remove thesource of the pain. This allows the doctor to treat your pain with accuracy and minimal damage to surrounding structures in the back. TELDF procedures offer a 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.