Failed back surgery syndrome (FBSS) is a misnomer, as it is not actually a syndrome – it is a very generalized term that is often used to describe the condition of patients who have not had a successful result with back surgery or spine surgery and have experienced continued pain after surgery. There is no equivalent term for failed back surgery syndrome in any other type of surgery (e.g. there is no failed cardiac surgery syndrome, failed knee surgery syndrome, etc.).
There are many reasons that a back surgery may or may not work, and even with the best surgeon and for the best indications, spine surgery is no more than 95% predictive of a successful result.
What Causes Failed Back Surgery Syndrome?
There are several reasons that a patient may feel pain after back surgery which results in failed back surgery syndrome.
Improper preoperative patient selection before back surgery. This is the most common cause of failed back surgery syndrome. Surgeons look for an anatomic lesion in the spine that they can correlate with a patients pain pattern. Some lesions are more reliable than others. For example, degenerative disc disease is less commonly correlated with patients back pain than leg pain from a disc herniation pinching a nerve root. There are other sources of pain that can mimic back pathology such as piriformis syndrome, sacroiliac joint pain and hip pathology (such as hip osteoarthritis).
Recurrent disc herniation after spine surgery. This is another common cause of recurrent pain after a discectomy/microdiscectomy spine surgery. The typical clinical picture is one where the patient initially has substantial pain relief, followed by a sudden recurrence of leg pain. In contrast to symptomatic pain caused by scar tissue (epidural fibrosis), in which symptoms tend to appear gradually, the symptoms of recurrent disc herniation tend to occur acutely. In addition to clinical history and presentation, an MRI scan is also useful in distinguishing the two pathologies.
Technical error during spine surgery. The spine surgeon must also consider technical error if there is continued pain after a discectomy or microdiscectomy or a laminectomy. For example, was a fragment of herniated disc material missed, or a piece of bone left adjacent to the nerve? In either case, the resulting compression of the nerve root could cause pain. Were the correct operative levels chosen during surgical planning? If not, an adjacent disc may be the true source of the pain. Again, postoperative imaging and clinical presentation will help answer these questions.
How Do We Treat Failed Back Surgery Syndrome?
At Pain Care Specialists of Oregon, we know how to treat failed back surgery syndrome. Our multidisciplinary approach incorporates state-of-the-art medical technology and the finest healthcare expertise to return you to a pain-free and active lifestyle. Our doctors and staff specialize in treating pain and the disorders that cause pain. We are experts in rehabilitation and will help you learn how you can help yourself recover from a back injury and a past failed surgery. Pain Care Specialists of Oregon will diagnose and treat it using cutting-edge technology and the finest medical attention.
If you are experiencing pain, please contact us to help relieve your pain and cure its cause.