WHAT IS FAILED BACK SURGERY SYNDROME?
Failed back surgery syndrome (also called FBSS, or Failed Back Syndrome) is a misnomer, as it is not actually a syndrome – it is a very generalized term that is often used to describe the condition of patients who have not had a successful result with back surgery or spine surgery and have experienced continued pain after surgery. There is no equivalent term for failed back surgery syndrome in any other type of surgery (e.g. there is no failed cardiac surgery syndrome, failed knee surgery syndrome, etc.).
There are many reasons that a back surgery may or may not work, and even with the best surgeon and for the best indications, spine surgery is no more than 95% predictive of a successful result. It is so common for patients to have pain after surgery that there is even an IDC10 code for doctors to classify (M96.1).
WHY DID MY BACK-SURGERY FAIL?
Spine surgery is basically able to accomplish only two things:
- Decompress a nerve root that is pinched, or
- Stabilize a painful joint.
Unfortunately, back surgery or spine surgery cannot literally cut out a patient’s pain. It is only able to change anatomy, and an anatomical lesion (injury) that is a probable cause of back pain must be identified prior to rather than after back surgery or spine surgery. By far the number one reason back surgeries are not effective and some patients experience continued pain after surgery is because the lesion that was operated on is not, in fact, the cause of the patient’s pain.
PREDICTABILITY OF PAIN AFTER SURGERY
Some types of back surgery are far more predictable in terms of alleviating a patient’s symptoms than others. For instance,
- A discectomy (or microdiscectomy) for a lumbar disc herniation that is causing leg pain is a very predictable operation. However, a discectomy for a lumbar disc herniation that is causing lower back pain is far less likely to be successful.
- A spine fusion for spinal instability (e.g. spondylolisthesis) is a relatively predictable operation. However, a fusion surgery for multi-level lumbar degenerative disc disease is far less likely to be successful in reducing a patient’s pain after surgery.
Therefore, the best way to avoid a spine surgery that leads to an unsuccessful result is to stick to operations that have a high degree of success and to make sure that an anatomic lesion that is amenable to surgical correction is identified preoperatively.
OTHER CAUSES OF FBSS AND CONTINUED PAIN AFTER SURGERY
In addition to the above-mentioned cause of failed back surgery syndrome, there are various other potential causes of a failed surgery, or continued pain after surgery:
FUSION SURGERY CONSIDERATIONS
– Failure to fuse and/or implant failure or a transfer lesion to another level after a spine fusion, when the next level degenerates and becomes a pain generator.
LUMBAR DECOMPRESSION BACK SURGERY CONSIDERATIONS
– Recurrent spinal stenosis or disc herniation, inadequate decompression of a nerve root, preoperative nerve damage that does not heal after a decompressive surgery or nerve damage that occurs during the surgery.
SCAR TISSUE CONSIDERATIONS
– “Epidural fibrosis,” which refers to a formation of scar tissue around the nerve root.
– Continued pain from a secondary pain generator.
As mentioned above, there is a considerably high percentage of patients who still have pain afterwards. Hopefully all other options were exhausted before surgery was performed to insure it was completely necessary. If chiropractic care was not utilized beforehand, it can be a great way to fix secondary problems that the surgery was not able to fix (e.g. facet syndrome, scar tissue, bulging discs & pinched nerves). There is almost never one thing gone wrong with the spine, which has caused the need for surgery. This is why it is so important to have these other conditions treated in order to ensure a complete recovery.