What is Failed Back Surgery Syndrome?
If back or neck surgery fails, there are still many good options for pain relief.
It’s never a casual decision to undergo back or neck surgery. So, when this more invasive treatment approach fails to alleviate chronic pain, a situation dubbed “failed spine surgery syndrome”, what can you do next? Fortunately, many treatment options can still save the day, according to Kaliq Chang MD, Interventional Pain Management Specialist with Atlantic Spine Center.
More than 600,000 spine surgeries happen in the United States each year, but only about 5% of patients undergoing these procedures still have significant, lingering pain after the operation and recovery period, explains Dr. Chang, who is fellowship-trained in orthopedic and spine neurosurgery. While no type of surgery works every single time – whether in the spine or another part of the body – it’s undoubtedly disappointing and distressing for patients whose back or neck surgery fails, as well as their surgeons.
“Symptoms of a failed back or neck surgery can include back, leg, or arm pain that’s dull and aching or sharp and stabbing, along with tingling, numbness, or muscle weakness,” he says. “The vast majority of back or neck surgeries, however, succeed in decompressing nerve roots that are pinched or in stabilizing painful spinal joints that led to the chronic pain, numbness or weakness in the first place.”
Failed Back Surgery Syndrome Causes
Why might back or neck surgery fail? It’s a vexing question and one with many possible answers, Dr. Chang says. There are several lower back pain causes. These include:
- Significant trauma, scarring and hardware used in and around the surgical site
- Inflamed joints at the surgical site
- Lingering disc herniation
- Undue stress on another weakened portion of the spine from the recovery process
- Improper fusion after spinal fusion
- Misaligned spine hardware
- Incomplete bone removal
- Disc space infection
- Nerve damage
- Inaccurate diagnosis of the original problem
“Whatever the reason for failed back or neck surgery, it’s important to point out that failure doesn’t mean you’re stuck with pain forever,” Dr. Chang notes. “Patients and doctors can and should work together to overcome the obstacles and find another solution that works.
Failed Back Surgery Syndrome Risks
Failed Back Surgery Syndrome (FBSS) refers to a condition where a patient continues to experience chronic pain and other symptoms after undergoing spinal surgery. While spinal surgeries can be beneficial for many individuals, there are certain risks and factors that can contribute to the development of FBSS.
Among the potential risks associated with FBSS are
- Surgical Complications: Like any surgical procedure, spine surgeries carry inherent risks. Complications such as infection, nerve damage, blood clots, or adverse reactions to anesthesia can occur. These complications can contribute to the development of FBSS.
- Incomplete Resolution of Underlying Condition: Spinal surgery aims to address specific spinal conditions, such as herniated discs, spinal stenosis, or degenerative disc disease. However, in some cases, the surgery may not completely resolve the underlying problem, leading to persistent or recurrent symptoms.
- Nerve Damage: Spinal surgeries involve working in close proximity to nerves, and in rare cases, nerve damage may occur during the procedure. This can result in ongoing pain, numbness, or weakness even after the surgery.
- Scar Tissue Formation: Following surgery, scar tissue can develop around the surgical site. In some instances, this scar tissue may impinge on nerves or other structures, causing pain and other symptoms.
- Failed Fusion: Spinal fusion surgeries involve fusing two or more vertebrae together to stabilize the spine. Sometimes, the fusion may not be successful, leading to persistent instability or abnormal motion in the spine, which can contribute to ongoing pain.
- Adjacent Segment Disease: Spinal surgeries can alter the biomechanics of the spine, placing additional stress on adjacent segments. Over time, this increased stress can lead to degeneration or the development of new spinal problems, resulting in FBSS.
- Psychological Factors: Chronic pain can have a significant psychological impact, including anxiety, depression, or increased pain sensitivity. These psychological factors can contribute to the experience of ongoing pain after surgery.
What is Failed Back Surgery Syndrome Treatment
How do you move forward after back or neck surgery that doesn’t work? With optimism, Dr. Chang advises. “Today more than ever there are many other treatments for pain, besides further surgery, and alternatives, other than more injections,” adds Dr. Chang.
The first step is ensuring your spinal diagnosis, failed back syndrome, is correct. To accomplish this, your doctor will use a variety of tests and tools that may include X-rays, MRI or CT scans, and nerve blocks or other injections. Once the cause of your ongoing back pain is revealed, it will likely be tackled using a blend of several lower back pain treatment approaches, he says. These can include:
- Exercise or physical therapy
- Medication for pain management
- Epidural steroid injections
- Nerve blocks
- Psychological counseling
- Spinal cord stimulation using a device that sends electrical pulses into the spine area
- Revision surgery
“It’s understandable to feel frustrated and defeated if your back or neck surgery doesn’t work, but it’s more than worth it to pursue a more precise diagnosis and appropriate treatment course for pain relief,” Dr. Chang says. “Be persistent and talk to your doctor.”
