Unraveling The Mystery of Failed Back Surgeries: What You Need to Know

 

Back pain affects millions worldwide. Surgery may be recommended when conservative treatments fail, but it can cause Failed Back Surgery Syndrome (FBSS). An interprofessional team is crucial. Understanding FBSS factors and using effective treatment strategies can improve patients' quality of life.

Back pain affects 1 in 10 people and causes more disability than any other condition globally. On the other hand, Failed Back Surgery Syndrome is a frustrating and debilitating experience for some patients who continue to experience pain after surgery. In the article, we will cover FBSS, including causes, treatment options, diagnosis with symptoms, and treatments. We'll share insights from experts like Dr. Andrew H. Milby, an orthopedic spine surgeon at Penn Medicine, to demystify this condition.

What is Failed Back Surgery Syndrome?

Failed Back Surgery Syndrome (FBSS) refers to the persistence or recurrence of symptoms in individuals who have undergone spinal surgery. It does not necessarily imply an error in the procedure, but rather signifies the ongoing presence of symptoms. FBSS can result from non-union or pseudoarthrosis, and continued degeneration at adjacent spinal levels.

Failed Back Surgery Syndrome (FBSS) refers to the persistence or recurrence of symptoms in individuals who have undergone spinal surgery. It does not necessarily imply an error in the procedure, but rather signifies the ongoing presence of symptoms. FBSS can result from non-union or pseudoarthrosis, and continued degeneration at adjacent spinal levels.

Etiology of Failed Back Surgery Syndrome

Failed Back Surgery Syndrome (FBSS) refers to the persistence or recurrence of symptoms in individuals who have undergone spinal surgery. It does not necessarily imply an error in the procedure but rather signifies the ongoing presence of symptoms. FBSS can result from non-union or pseudoarthrosis, and continued degeneration at adjacent spinal levels. 

Failed Back Surgery Syndrome (FBSS) is the persistence or recurrence of symptoms in individuals who have undergone spinal surgery. It does not necessarily imply an error in the procedure but rather signifies the ongoing presence of symptoms. FBSS can result from non-union or pseudoarthrosis, and continued degeneration at adjacent spinal levels.

Presentation of Failed Back Surgery Syndrome

FBSS symptoms include persistent back pain, radicular pain, neuropathic pain, and limited physical function. Psychological distress, such as depression and anxiety, can exacerbate pain. Thorough history-taking and physical examination are necessary for accurate diagnosis and treatment.

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Underlying Causes of Recurrent Back or Leg Pain

Non Union or Pseudoarthrosis

Non-union or pseudoarthrosis is the failure of solid spinal fusion to form after surgery. It can cause instability and worsen the patient's condition. Spinal fusion aims to stabilize the spine and promote healing, but when it fails, it can lead to complications. When bones don't heal properly after a surgical fusion, screws, and rods can loosen or break over time, causing new back pain or leg symptoms. This is called pseudoarthrosis and is more likely to occur in people who smoke, are obese, or have poor bone quality.

Continued Degeneration at Adjacent Levels

Back or leg pain after surgery can recur due to the natural progression of spinal degeneration at levels adjacent to the previous surgical site. While surgery may be successful at one level, wear and tear can continue to affect other levels over time.

Recurrent pain may occur years after successful surgery. Patients may need further treatment, such as physical therapy or medication.

Multidisciplinary Approach to Failed Back Surgery Syndrome

FBSS management requires a multidisciplinary team of healthcare professionals who collaborate to develop an individualized treatment plan addressing physical and psychological aspects.

Surgical Options

Surgery may be needed for FBSS but should be approached with caution due to lower success rates and higher risks. Options include decompression, spinal fusion, or other techniques specific to the pathology. Consider the patient's symptoms, imaging, and health before deciding.

Neuromodulation 

Spinal cord stimulation (SCS) is an effective treatment option for failed back surgery syndrome (FBSS). It involves implanting a device that delivers electrical impulses to the spinal cord, reducing pain signals and improving quality of life. Although SCS is not suitable for all FBSS patients, careful patient selection is essential.

Diagnostic Evaluation for Failed Back Surgery Syndrome

To diagnose FBSS, healthcare providers utilize various diagnostic modalities. X-rays are often the first imaging evaluation, allowing the detection of vertebral abnormalities and misalignments. They are limited in assessing soft tissue structures. 

MRI with contrast is considered the gold standard for evaluating FBSS, as it provides detailed images of the spine and can identify specific pathologies such as epidural fibrosis or disc herniation. Other tests, such as erythrocyte sedimentation rate and C-reactive protein, may be used to rule out infection or other systemic conditions.

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Conclusion

Failed Back Surgery Syndrome can cause ongoing back or leg pain after spinal surgery. Identifying causes like non-union and adjacent level degeneration is crucial for effective treatment. Consider non-surgical options and confirm the diagnosis. To find relief from Failed Back Surgery Syndrome, understand the condition and find effective solutions.

FBSS is a complex condition that challenges patients and healthcare providers. A comprehensive approach, involving conservative management, interventional procedures, and surgery when necessary, is key. Through interdisciplinary collaboration, patients can receive optimal care and support on their journey toward recovery.