What is failed back surgery syndrome?
Failed back surgery syndrome (FBSS) means persistent or recurrent symptoms in a patient who has had previous surgery on their spine.
Perhaps you had surgery and it relieved your symptoms for a while but now they’re back. Or perhaps the surgery did not alleviate your symptoms at all.
Sometimes the symptoms shift after surgery too, meaning you might now have new leg pain instead of back pain, for example.
Does FBSS always mean the surgery failed?
No. It’s a more complicated picture than that.
Sometimes it is fair to say that back surgery failed. Often, though, the surgery has gone well but the condition has progressed in some way or the surgery has fixed one problem but made you more susceptible to another. Sometimes, too, we have unrealistic expectations of what life will be like after surgery, not realising that some pain often persists.
Why does failed back surgery syndrome happen?
FBSS can happen because something went wrong during surgery –the risks of surgery should have been disclosed by your surgeon prior to surgery and can include nerve injury, inadequate decompression, vertebral fracture, implant malposition, infection, non-union and adjacent segment degeneration.
Symptoms can also persist if your condition was misdiagnosed. That means that the surgery, no matter how well it was done, did not address the true cause of your pain, which may be for instance an injury to the sacroiliac joint rather than a problem with your spine.
However, FBSS can also happen when the surgery itself did not really fail at all. Often, surgery went well but:
- Healing has been incomplete
- In spinal fusion, for example, the bone is stabilised by rods and screws during surgery but fuses slowly over the following weeks and months, much as a broken bone might heal inside a cast. In a small number of cases, the bone doesn’t knit together as it normally should and the screws and rods over time can work loose.
- Pain can come from altered mechanics following surgery
- Any surgery on your spine alters its mechanics, causing more pressure on areas surrounding the site of the surgery.
- A laminectomy or microdiscectomy involves removing supporting structures around the spinal column which can contribute to instability and new pain.
- A spinal fusion reduces movement in one part of your spine and if it has not been aligned in the correct position this can lead to accelerated problems above or below the fusion. A loss of sagittal balance has been recently found to be very common following lumbar fusion and may be a cause for onging pain.
- Adjacent segment degeneration
- There’s continued, normal degeneration in other areas of your spine, due to continuation of the same condition (such as disc degeneration or facet arthritis) in a different part of your spine. That can cause very similar symptoms to the original condition after a successful surgery.
- There were unrealistic expectations of a pain-free, problem-free life after surgery. Despite highly skilled surgeons and advanced techniques, we know that:
What’s the treatment for failed back surgery syndrome?
There’s ongoing research into this question because we know it’s distressing for patients to live with pain that limits their enjoyment of daily life.
In many cases, we can find a reasonable explanation of why surgery hasn’t relieved your pain. So, we start with a systematic evaluation looking for common culprits such as:
- Residual, recurrent or new-onset stenosis
- Recurrent disc herniation
- Epidural fibrosis (scar tissue in the spine),
- Non-union of vertebrae following spinal fusion
- Loose screws or implants
- Sagittal imbalance or scoliosis.
We also look beyond your spine to other conditions that reside elsewhere but can nonetheless cause back pain including:
- Compressed nerves outside the spine such as meralgia paresthetica
- Nerve-related conditions including peripheral neuropathies and multiple sclerosis
- Arthritis of the hip
- Kidney disease
- Abdominal aortic aneurysm
- Arterial stenosis (narrowed arteries).
If a particular cause is identified, then your treatment may include:
- Pain relief, through both medication and desensitisation
- Procedures such as injections, nerve blocks or spinal cord stimulation
- Revision surgery where you have another spinal operation to relieve the new problem.
How The Victorian Orthopaedic Spine Service can help
We take failed back surgery syndrome seriously and have careful procedures in place to minimise the risk of it developing.
Before surgery, that includes thorough examination and testing to reach an accurate diagnosis, attempting conservative treatments before recommending back surgery, and counselling you on the risks, benefits and likely outcomes of surgery before you decide how to proceed.
After surgery, it involves appropriate after care to check on progress and evidence-based rehabilitation to help you gain the most from your surgery.
For patients who do experience ongoing pain after surgery (whether performed here or by another surgeon elsewhere), we’re able to investigate thoroughly and recommend treatments to help at this stage of your journey.
Please contact us today if you’d like help with failed back surgery syndrome.
All information is general in nature. Patients should consider their own personal circumstances and seek a second opinion. Any surgical or invasive procedure carries risks.
About Dr David Edis
Dr David Edis is an Orthopaedic and Spine Surgeon. David’s areas of special interest include the management of adult spinal conditions as well as hip and knee replacements. He has extensive experience in all facets of spine surgery from simple to complex, covering cervical to lumbo-pelvic conditions. He is an active researcher and medical educator and believes in lifelong learning. He is constantly updating his skills and helping other surgeons.