The Basics of Failed Back Surgery Syndrome


chronic pain pictureFailed back surgery syndrome (FBSS) is a medical term used to describe a condition that occurs when a patient has back surgery that does not relieve pain and other symptoms. The purpose of spinal surgery is to decompress pinched nerves, correct spinal deformities, and stabilize a spine segment that is moving abnormally. For some patients, spine surgery does not cure the pain. When pain persists after surgery, it is called FBSS.

Causes of Pain after Back Surgery

  • Failure of the spine to fuse
  • Recurrent disc herniation
  • Failed spinal implant
  • Continued nerve compression
  • Pain from another area of the spine
  • Nerve damage that does not resolve

Risk Factors for FBSS

Several factors that contribute to the onset or development of FBSS. These include:

  • Persistent post-operative pressure on a spinal nerve
  • Recurrent or residual disc herniation
  • New bulging disc
  • Altered joint mobilityBackPain
  • Joint hypermobility with instability
  • Depression and/or anxiety
  • Scar tissue formation (fibrosis)
  • Spinal muscular deconditioning
  • Systemic disorders (diabetes, peripheral vascular disease, and autoimmune diseases)
  • Smoking

Symptoms of FBSS

A patient with FBSS will usually complain of pain that is equal to or worse than the pain he/she had before spine surgery. The pain can be similar to what was felt before, or it can be of a different quality and occur in another location. Most patients with FBSS complain of back pain, pain that radiates down the leg, leg numbness/weakness, and stiffness of the spine. FBSS affects around 25% of people who have surgery on the spine.

Procedures effective for Back Pain

If you have persistent back pain that remains after back surgery, consider having one of these procedures.

  • Facet joint injection – With this procedure, the doctor injects the facet joint (between the vertebrae) with an anesthetic and steroid medication. This is done to provide long-lasting pain relief.

 

  • Facet joint denervation – With this procedure, the doctor uses x-ray guidance to insert a needle into the facet joint. He/she then uses radiofrequency energy to heat the tissue to coagulate and deaden the nerves.Lumbar_Transforaminal_Epidural

 

  • Epidural steroid injection (ESI) – Similar to a facet joint injection, the ESI involves injecting the epidural space with medications to reduce inflammation and provide pain relief.

 

  • Selective nerve root block (SNRB) – Primarily used to diagnose the source of nerve root pain, this procedure can also be used to give pain relief to the patient. The doctor injects the nerve roots with a neurolytic agent (absolute alcohol or phenol) to destroy the nerves.

 

  • Lumbar sympathetic nerve block – With this block, the doctor injects a neruolytic agent directly onto the sympathetic nerves, which innervate the lower back and legs.

 

  • Spinal cord stimulation – This invasive technique involves the implantation of a small unit near the spinal cord to deliver electrical currents.

 

Resources

Hussain A & Erdek M (2014). Interventional pain management for failed back surgery syndrome. Pain Practice, 14(1), 64-78.