Failed Back Surgery Syndrome

When it comes to identifying types of pain, there are two types: acute and chronic. Acute pain comes on quickly, can be severe but only lasts a relatively short time. It is typically experienced after an injury or trauma, and self-resolves. 

Unlike acute pain, chronic pain is pain that lasts for a long time, and doesn't seem to get better or go away. This time period can vary but is typically defined as a three- to six-month period after symptoms begin. Chronic pain is often a debilitating symptom of many diseases and is considered a disease itself when it persists beyond recovery from an injury or illness. Chronic pain is a frequent component of many neurological disorders. 

Pain warns you that something is not quite right in your body and can cause you to take certain actions and avoid others. Pain can significantly impact your quality of life—by adversely affecting your physical and emotional well-being; upsetting relationships with family, coworkers and friends; and limiting your mobility and participation in daily activities.

Hundreds of pain syndromes or disorders make up the spectrum of pain. One cause of pain is failed back surgery syndrome (FBSS). FBSS is lumbar spinal pain that persists despite surgical procedures or that appears after spinal pain surgery for a nearby location in the back. It occurs when surgery fails to treat the patient’s lumbar spinal pain. 

Pain types associated with failed back surgery syndrome (FBSS) include persistent, dull and aching pain that involves either the back or legs or both, not associated with the healing process. This pain results from an unsuccessful back surgery that did not repair damage.

Failed back surgery syndrome (FBSS) may be caused by either pre- or postoperative risk factors. Preoperative contributors may include smoking, obesity or psychiatric disorders (such as depression or anxiety). Postoperative contributing factors may include progression of degenerative changes (new or recurrent disc herniation), or muscular hypertrophy, atrophy and spasms.

Risk factors for FBSS include a poorly preoperative diagnosed patient for surgery. Some lesions respond better to surgery than others, primarily patients with anatomic lesions in the spine. Other risk factors include age, hypertension, preoperative pain, symptom location and postoperative rehabilitation success.

Like most spinal disorders, FBSS can be diagnosed using imaging scans such as X-rays, computed tomography (CT) and magnetic resonance imaging (MRIs). The type of scan depends on the original preoperative diagnosis requiring the surgery.

Symptoms of FBSS typically involve exacerbated preexisting symptoms or new symptoms. They might include one or more of the following:

• Postoperative back spasms, stabbing pain or radiating pain
• New pain at a new level of intensity or from a new location
• Restricted mobility
• Anxiety and depression
• Inability to recuperate and/or dependence on pain medication
• Sleeplessness

Failed back surgery syndrome (FBSS) is defined as lumbar spinal pain of unknown origin persisting despite surgical intervention or appearing after surgery for spinal pain originally in the same topographical location.

Treatment of FBSS may include medication, physical therapy or a follow-up surgical procedure. Failing success of medication and/or physical therapy, non-surgical treatments may include:

• Racz catheter procedure, also known as an epidural neurolysis, wherein the doctor injects an enzyme into the area to be treated to soften the scar tissue, thereby reducing inflammation which may be causing pain
• Radiofrequency ablation, which destroys the nerves around the spine that are sending pain impulses to the brain
• Facet joint injections to reduce inflammation in the joints.
• Nerve stimulation devices using electrodes to manage chronic pain

Living with FBSS means pain management using a range of solutions from prescribed pain medication, physical therapy or a follow-up medical procedure. Work with your physician to obtain a diagnosis and the best treatment program to ease your pain or to plan corrective procedures.