Back pain is a prevalent ailment that can drastically alter the course of an individual’s life, leading many to seek surgical solutions with the hope of finding relief. However, for some, this relief remains elusive, even after undergoing spinal surgery. This condition is known as Failed Back Surgery Syndrome (FBSS), a complex disorder characterized by persistent or new pain following spinal surgery. Understanding the symptoms of failed back surgery syndrome is crucial for patients and healthcare professionals alike, as it lays the foundation for managing and potentially overcoming the challenges this condition presents.
This article offers a comprehensive guide to recognizing failed back surgery syndrome symptoms, exploring the common signs such as chronic back pain, leg pain, muscle spasms, and nerve pain, among others. It delves into the factors contributing to FBSS, including scar tissue formation, nerve compression, and inadequate surgical procedures like laminectomy or spinal fusion. Moreover, the importance of diagnostic tests, including MRI and CT scans, in identifying underlying issues will be highlighted. Treatment options, ranging from nonsurgical treatments like physical therapy to revision surgery, will be discussed to provide readers with a roadmap to living with and managing FBSS. Through a better understanding of failed back surgery syndrome symptoms, patients can embark on a path towards improved health and quality of life.
Understanding Failed Back Surgery Syndrome (FBSS)
Definition and General Overview
Failed Back Surgery Syndrome (FBSS), as defined by the International Association for the Study of Pain, refers to lumbar spinal pain of unknown origin that persists or appears after surgical interventions intended to alleviate spinal pain in the same topographical location. This condition encompasses a broad spectrum of issues that may arise post-surgery, including persistent, exacerbated, or insufficiently alleviated pain. The term highlights a critical and unfortunate outcome where surgical solutions do not achieve the desired relief or inadvertently worsen the patient’s condition.
Common Terminology
Historically, the terms “post-laminectomy syndrome” and “failed back surgery syndrome” emerged in the 1970s and gained prominence in the 1980s. These terms describe a heterogeneous group of disorders characterized by chronic pain following spinal surgery. The terminology itself, particularly the use of “failed,” carries significant ethical implications, suggesting a blame that may fall unjustly on patients or physicians. This has led to discussions about renaming the syndrome to avoid stigmatization and more accurately reflect the complex nature of the condition. The recent proposal to adopt terms like PSPS (Persistent Spinal Pain Syndrome) aims to provide a more precise and less pejorative description, fostering a better understanding and management of the syndrome. Don’t let ongoing pain hold you back. Dr. Rosenstein in Arlington, Texas, specializes in providing positive outcomes for patients who continue to experience pain after previous spine surgeries. Schedule your consultation today and take the first step towards a pain-free life. Contact us at 817-767-0246 or visit our website at ntneurosurgery.com.
Common Symptoms of FBSS
Persistent Pain
Patients often report persistent pain as a hallmark of Failed Back Surgery Syndrome (FBSS). This pain might not only continue after surgery but could also reappear days or weeks later. It typically manifests as a dull, aching sensation that can become sharp and stabbing, particularly in areas not directly associated with the surgical site. Such chronic pain conditions are deeply linked to the surgery’s inability to resolve the underlying spinal issues fully. Understanding Failed Back Surgery Syndrome (FBSS) can be disheartening for those seeking relief through surgery. It’s important to know that persistent pain doesn’t define your journey. Many patients face similar challenges and find effective ways to manage symptoms.
Nerve Pain
Nerve pain in FBSS is frequently described by patients as burning, gnawing, or radiating pain that does not change with position. This type of pain often results from nerve damage or scarring, such as epidural fibrosis, which affects the nerve roots. Symptoms like numbness, tingling, and a stinging sensation in the legs are common, indicating persistent nerve irritation or damage.
Limited Mobility
FBSS can significantly restrict a patient’s mobility, making it difficult to perform daily tasks and reducing their quality of life. This limitation often stems from the mechanical inefficiencies and pain caused by the surgery, such as in cases where spinal fusion reduces spinal mobility and increases stress on adjacent spinal levels. Over time, this can lead to further degeneration and the need for additional surgical interventions.
Chronic Pain
Chronic pain associated with FBSS is complex and multifactorial, often involving both nociceptive and neuropathic pain components. Patients may experience a continuous, deep ache that doesn’t necessarily correlate with physical activity or posture. This pain is exacerbated by biological, psychological, and social factors that influence the overall outcome of spinal surgeries. Effective management often requires an integrated approach, including advanced pain relief modalities like neuromodulation, which targets the specific types of pain experienced by the patient.
Factors Contributing to FBSS
Pre-surgical Factors
The onset of Failed Back Surgery Syndrome (FBSS) can often be traced back to factors existing before the surgery itself. Patients with psychological issues such as anxiety and depression are particularly at risk. Chronic habits that compromise general health, such as smoking, along with pre-existing medical conditions like obesity, significantly contribute to the risk. The presence of litigation or workers’ compensation claims also plays a role. Additionally, certain physical or radiologic findings, including stenosis, fibrosis, and disc herniation, heighten the likelihood of FBSS.
Surgical Factors
Choosing an inappropriate surgical candidate or surgical technique can lead to FBSS. This includes operating at the wrong vertebral level or addressing only a single level when the origin of pain spans several levels, thus providing insufficient relief. Furthermore, improper surgical techniques may fail to alleviate pain or could even lead to new pain post-surgery. These intraoperative decisions critically influence the surgery’s success and the patient’s recovery trajectory.
Post-surgical Factors
Post-surgical factors contributing to FBSS include the progressive degeneration of the spine, the development of new spinal conditions, and increased stress and trauma to levels adjacent to the treated spinal segments. Not adhering to post-operative instructions regarding activity restrictions can impede healing and exacerbate pain. Additionally, a failed bony fusion (pseudoarthrosis) or implant failure can result in continued pain, loss of function, and development of new symptoms. These factors collectively highlight the complexity of managing and preventing FBSS post-surgery.
Diagnosing FBSS
Physical Examination
In diagnosing Failed Back Surgery Syndrome (FBSS), a thorough physical examination is essential. Physicians typically begin by reviewing the patient’s medical history and previous surgical details to understand the context of the current symptoms. They assess for signs of heaviness, numbness, or weakness in the limbs, which could indicate nerve involvement. The level, nature (sharp or dull), and behavior (ongoing or intermittent) of the pain are also crucial diagnostic indicators, especially if the pain varies with changes in posture, such as standing or sitting.
During the examination, doctors look for restricted movement in the spine or neck and check for muscle strength to identify any weakness that might suggest nerve compression. Observing the spine in motion, through activities like walking or bending, helps in evaluating spinal dynamics. Neurological evaluations are also conducted, which may include reflex tests using a small hammer to identify unresponsive nerve reflexes—a potential sign of nerve impingement.
Imaging Tests
Imaging plays a pivotal role in the diagnosis of FBSS. X-rays are often the first step, providing valuable insights into vertebral alignment and structural issues like spondylolisthesis. However, for a more detailed assessment of soft tissues, MRI scans are preferred. MRI provides high-resolution images of ligaments, discs, and other spinal structures, crucial for identifying conditions like epidural fibrosis or disc herniation.
In cases where MRI is contraindicated, such as in patients with pacemakers or certain implants, CT scans are utilized. These scans offer superior imaging of bone structures and can be crucial in spotting bone spurs or fractures. Advanced techniques like EOS® imaging, which produces three-dimensional views of the spine, are used less frequently but can be instrumental in planning further surgical interventions by providing a comprehensive view of spinal alignment.
For more specific diagnostic needs, such as confirming nerve root compression or identifying the exact source of pain, diagnostic nerve blocks may be employed. These procedures not only help in pinpointing the affected areas but also provide temporary relief from pain, assisting in the overall management of FBSS.
By integrating both physical examinations and advanced imaging techniques, healthcare professionals can effectively diagnose and manage Failed Back Surgery Syndrome, paving the way for tailored treatment strategies.
Treating FBSS
Non-surgical Treatments
Failed Back Surgery Syndrome (FBSS) often presents a complex challenge, requiring a multifaceted approach to management. Initial treatments typically focus on non-surgical methods. Physical therapy is fundamental, aiming to strengthen the muscles supporting the spine and improving posture, which can alleviate pressure on spinal nerves. Pain medication, including nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants, plays a crucial role in managing inflammation and muscle spasms that contribute to discomfort. Finding a compassionate healthcare team, like at Rosenstein, who understands your unique needs can make a significant difference. We tailor treatments to address your specific symptoms, guiding you with empathy and expertise.
For more targeted pain relief, interventional procedures such as epidural steroid injections (ESIs) and nerve blocks can be highly effective. These treatments deliver powerful anti-inflammatory medication directly to the affected areas, providing significant pain relief. Additionally, advanced techniques like spinal cord stimulation (SCS) have shown promising results. SCS involves the use of a device that sends electrical impulses to the spinal cord, which can help mask pain signals before they reach the brain.
Surgical Options
When non-surgical treatments do not provide sufficient relief, surgical interventions may be considered. However, it is important to note that re-surgery is only effective in a limited number of cases, ranging from 5-30%. The decision to proceed with further surgery should be based on a thorough evaluation of the patient’s specific condition and the reasons behind the failure of the initial surgery.
In some instances, procedures like percutaneous endoscopic adhesiolysis may be recommended to address scar tissue that can entrap nerves post-surgery. For severe cases, where nerve damage or structural issues persist, revision surgeries such as laminectomy or foraminotomy may be necessary to relieve nerve compression and restore spinal stability.
The choice of treatment should always be tailored to the individual’s specific symptoms and medical history, ensuring the best possible outcome. Don’t let failed back surgery define your life. Dr. Rosenstein is dedicated to helping you achieve lasting relief. Contact us at 817-767-0246 or visit ntneurosurgery.com to schedule your consultation.
Living with FBSS
Managing Symptoms
Living with Failed Back Surgery Syndrome (FBSS) involves an ongoing process of managing symptoms to enhance quality of life. Individuals often continue to experience the same pain that led them to surgery, including persistent back and leg pain, numbness, and tingling sensations. To address these challenges, a combination of medication management, physical therapy, and minimally invasive procedures is often recommended. Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to reduce inflammation and pain, while physical therapy exercises can help strengthen the back, improve mobility, and alleviate pressure on nerves. For those who find limited relief from these methods, advanced options like microcurrent electrical neuromuscular stimulators or nerve blocks may be considered to better manage pain.
Psychological Support
The impact of FBSS is not only physical but also psychological, affecting mental and emotional well-being. Many individuals face anxiety, depression, and sleep disturbances due to chronic pain and limited mobility. Engaging with a multidisciplinary team is crucial, where psychological support plays a significant role. Techniques such as cognitive-behavioral therapy and mindfulness meditation can be effective in improving coping mechanisms and enhancing mental resilience. Acceptance of chronic pain and learning to adapt daily activities accordingly are vital steps in the process. Ongoing support from healthcare professionals, including psychologists and pain management specialists, helps individuals navigate the complexities of FBSS, focusing on both symptom management and psychological well-being. Approach your journey with optimism. A comprehensive treatment plan, combining medical care, physical therapy, and psychological support, can improve your quality of life. With dedication, many patients achieve meaningful relief and regain independence.
Conclusion
Even if your pain worsens post-surgery, most physicians will be hesitant to operate again until you’ve fully healed. So your best hope for help is to try less aggressive treatments. If you’ve had surgery, you’ve likely already tried exercising, physical therapy, and non-steroidal injections. If not, do so. Intrathecal drug delivery skips oral drug consumption. Professionals insert a catheter to carry drugs directly into the spinal fluid. Doing so reduces the amount of medication needed and the number of side effects. Radiofrequency neurotomy identifies the nerve that is the source of your chronic pain. From here, doctors insert a heated needle to destroy the problem nerve while avoiding damage to surrounding nerves. Electrical neurostimulation is a procedure that installs a device into a patient’s back. This device sends controlled amounts of electricity to the spine, reducing pain. Research suggests that this procedure is more effective at reducing complications than reoperation. Whatever path you take, ask your therapist about an exercise program to strengthen your core. Schedule a conversation with Accelerated Interventional Orthopedics today to learn your options for dealing with failed surgery syndrome. Our team will work with you one-on-one to find the best long-term solution for your problems. Verify the chances of your back surgery’s success. Consider using non-surgical treatment to reduce chronic back pain. Certain treatments have a higher rate of success than operating. There’s one hard truth about failed back surgery syndrome (FBSS). And it’s this… If you’re struggling with FBSS, there’s a chance that you may never completely eliminate your symptoms. And the chances of developing FBSS increase with each additional back surgery. Nerve damage and structural changes to the spine may cause pain to continue. And more involved surgeries bring their own set of risks. In this case, the focus should be on managing back pain over time. Thankfully, there are steps you can take to manage pain and other symptoms. Strong core muscles improve spinal stability and reduce some of the wear and tear that can occur with aging. Working with a Medical Exercise professional can help you identify your spinal “neutral”. Meaning, the spinal position where you feel less pain. Improving your ability to maintain this position while performing your daily activities is key to preventing pain symptoms and the risk of injury. Proper breathing can help restore function of the abdominal muscles and reduce the stress on muscles of the shoulders and neck when we breathe incorrectly. Reducing stress, a healthy diet, and other lifestyle changes can also help you manage persistent back pain after surgery. With the help of your physician, physical therapist, and exercise professional, you can safely return to function and do the things you love doing with minimal pain. The goal should be to improve your quality of life. And although that may not equate to pain-free living, it can reduce the impact that failed back surgery syndrome can have on your life. Take control of your pain today. Dr. Rosenstein offers specialized care for those suffering from ongoing pain after spinal surgery. Schedule your consultation now by calling 817-767-0246 or visiting ntneurosurgery.com.
FAQs
- What are the treatment options for failed back syndrome?
Treatment for failed back syndrome may involve several approaches including medications to alleviate pain and reduce inflammation, physical therapy to improve mobility, and nonsurgical procedures like injections, radiofrequency ablation, or softening of scar tissue. In some cases, an additional surgery might be necessary. - Can failed back surgery syndrome be considered a disability?
Yes, failed back surgery syndrome is recognized as a debilitating condition that can significantly impair one’s ability to work. Many affected individuals find it necessary to file for long-term disability insurance benefits to manage their financial needs due to their inability to continue working. - What are the symptoms of failed back syndrome?
Individuals with failed back syndrome typically experience sharp, stabbing pain in the back, numbness or pain that radiates from the lower back to the legs, muscle spasms in the back, and accompanying issues such as anxiety, depression, and sleep disturbances. - What is the updated terminology for failed back syndrome?
The term “Failed Back Surgery Syndrome (FBSS)” has been updated to “Persistent Spinal Pain Syndrome (PSPS-T1/2).” This new terminology reflects a more current understanding of chronic spinal pain following surgery and influences how such post-surgical pain conditions are diagnosed and treated.