Failed Back Surgery
This unfortunate term refers to any person with ongoing significant pain and disability after having spinal surgery. It implies that surgery has been done and that there is no ongoing mechanical explanation for ongoing symptoms.
It encompasses many conditions and complications after surgery and is not a single entity. For many patients, there is a reasonable explanation of why their surgery has not relieved their pain and these known complications need to be looked for before a patient should be given this “label”. Some of these complications are reversible but may require specialist evaluation with special tests to make the correct diagnosis.
Conditions to be looked for include:
- adjacent segment degeneration
- non-union of a fusion
- residual or recurrent spinal stenosis
- loss of fixation or loosening of implants
- spinal imbalance – sagittal or scoliosis
- neural compression outside the spine eg Meralgia parasthetica
- non-surgical neurological conditions eg Neuropathies, spinal cord disease (e.g. MS)
- non-spinal causes of back/leg pain eg arthritis of the hip, kidney disease, abdominal aortic aneurism or arterial stenosis.
Chronic or Persistent Pain Syndrome
Some patients do have an element of central neuro sensitisation that contributes to the ongoing pain experience despite apparently successful surgery and this also needs to be considered. It is increasingly understood that pain is best understood as more than just a biological phenomenon and the social and psychological factors contribute to persistent pain and may also need to be addressed in the successful management plan.
This condition is a serious concern for David Edis and his team at VicOrthospine. Through both pre and post surgery treatment we attempt to minimise all possible causes.