By: Dr. Rami Rustum – Nov. 2016
Failed Back Surgery Syndrome (FBSS) refers to a group of patients who have new or persistent pain after spinal surgery for back or leg pain. The same term applies for continuing pain in the neck or arm following neck surgery.
The pain can be reduced but still present, or may get worse within a few months after surgery due to a buildup of scar tissue around spinal nerve roots, along with persistent tissue pain and muscle spasm. The term refers to a condition of continuing pain and is not meant to imply there was necessarily a problem during surgery.
In general, there are two primary reasons chronic pain may persist after someone undergoes a major back operation.
First, for a variety of reasons, the patient may not have been a good candidate for surgery to begin with. This can be due to a misdiagnosis or a pre-surgery physical evaluation that was not thorough. Either way, if a patient is not a good candidate for spine surgery, the surgery has the potential to create new symptoms outside of the ones already experienced by the patient.
Second, the procedure may have been performed incorrectly. In the midst of the highly invasive nature of traditional open back surgery, a nerve root may be damaged or excessive blood loss may prevent the surgery from being performed with absolute precision.
Specific causes of FBSS include:
• Surgery performed at incorrect location
• Bone graft rejection
• Fusion hardware failure
• Scar tissue compressing a nerve root
• Inadequate decompression of affected nerve or nerves
• Postoperative infection
The most obvious symptom of failed back surgery syndrome is persistent, chronic pain that is not associated with the healing process. Other symptoms associated with FBSS include:
• New pain at a level different from the location treated
• Inability to recuperate
• Restricted mobility
• Sharp, stabbing back pain
• Numbness or pain radiating through the lower back into the legs
• Back spasms
• Anxiety, depression and sleeplessness
• Potential dependence on pain medication
After detailed physical exam and evaluation for the pain case trying to identifying specific reason for the pain if possible and obtaining diagnostic studies such as spine x-rays, CT or MRI studies, the Pain Specialist will draft the best possible treatment plan based on the above findings:
Medication may be necessary to alleviate some of the patient’s pain. Medications may include analgesic and anti-inflammatory medications, including non-steroidal anti-inflammatory drugs (NSAIDs). Additionally, some patients may be prescribed opioids for short-term pain relief. Furthermore, certain antidepressants medications may be prescribed.
Physical therapy, chiropractic care, transcutaneous electrical nerve stimulation (TENS), may also be recommended as complementary treatments for patients suffering with failed back surgery syndrome.
Epidural steroid injections, nerve blocks, and trigger point injections may also be suggested to help alleviate a patient’s pain. Epidural steroid injections consist of injecting a corticosteroid, combined with a local anesthetic, into the epidural space of the affected area. Nerve blocks consist of injecting medication close to or directly into a nerve root to help block pain signals. Trigger point injections involve injecting medication directly into a trigger point to help relieve pain.
If the pain associated with failed back surgery syndrome does not respond to initial pain management therapies, spinal cord stimulation (SCS) may be recommended. This therapy involves implanting stimulating electrodes in the epidural space and implanting a small electrical pulse generator near the spine that is connected with conducting wires. These devices usually have a remote control. Spinal cord stimulation delivers small, electrical impulses to the spinal cord to help control chronic pain.
While not all therapies may provide complete relief of symptoms, physicians will help to design the best treatment plan to help eliminate as much pain as possible. A combination of treatment options usually provides the best possible treatment outcomes.