Failed back surgery syndrome is the condition of the patient who underwent spine surgery but having continued pain even after surgery. FBSS is not really a syndrome but is a misnomer used to describe the condition of such patients. Any type of surgery always carries some risk even if it is minor operation. Nobody can predict the outcome as 100% success rate. The outcome has more amounts of risk than any other surgery.
Even a best neurosurgeon cannot guarantee for complete recovery after he opens the spinal cord of the person, since complications can occur during the process of surgery. Failed back surgery syndrome has no other alternative name.
Two Types :
Patients who have underwent spine surgery but continue to have pain can be broadly categorized into two types. The first group is one in which surgery was never the solution for the problem or it was told that the surgery may not give the desired result or surgery was done but it was not able to achieve the desired response/result. The second group of patients includes those for which the surgery was incomplete or inadequate for the problem. Very often, in Spinal Stenosis along with disc protrusion can give unsatisfactory results. Sometimes, surgery will be done for the wrong level. There is every chance for achieving other problems due to inadequate surgery.
Who are at risk?
Smoking persons have increased chances for developing failed back surgery syndrome. Most of the time, spine surgery may not fetch the desired outcome in cigarette smokers. It is believed that nicotine present in the cigar will affect the bone metabolism causing spinal problems in the long run. It can also cause damage to the thickness of blood vessel producing scars.
Symptoms :
The intensity of pain may vary from one person to another and also on the causative factors that is responsible for pain. Some of the common symptoms of failed back surgery syndrome are dull aching pain on the legs and on your back. The pain will start within 3-4 weeks of surgery or as soon as your doctor stops pain-killer medications. For some there can be sharp stabbing pain on the legs and hands with pricking sensation.
Causes :
The aim of spine surgery is to get relief from pain and to stabilize the joint. Its goal is to decompress the nerve root that is protruding and causing the problem. However the spine surgery will not provide complete relief from the back pain. The surgeon can try his best possible to fix the anatomical problem and to remove any lesions that is the root cause for pain.
The root cause of the problems should be identified before the surgery failing which it is of no use to do surgery. Many doctors assume that it is the lesion that causes pain which actually is not the reason for pain. Hence after surgery also, the patient will complain of intense pain even after the removal of lesion. Some type of fusion surgery may not give positive results since it may lead to failure to fuse together or cause lesions on another level causing pain after surgery. During lumbar decompression surgeries, it can cause nerve damage inducing pain after surgery. Epidural fibrosis can lead to the scar tissue formation causing consistent pain.
There can be recurrent pain after discectomy spine surgery. Before taking decisions about surgery, the surgeon has to consider clinical history of the patient, scan reports and several other factors. Sometimes technical error happens during spine surgery if a fragment of the disc (herniated) was left inside. It can cause compression of the nerve root leading to intense pain.
Predictable back surgery :
Not all the spine surgery can be predicted about the outcome. Only few of them are predictable in relieving the symptoms of the patient. Discectomy (where the lumbar disc herniation is the root cause) surgery on the leg is predictable and leg pain can be completely treated. But the same surgery cannot be effective if the pain is in the back region.
Spine fusion surgery also called spondylolisthesis can give predictable results. Here again if the same surgery is done at multi level lumbar degeneration cannot be predicted for giving the best outcome. Before signing the papers, the patient should consider several factors and avoid surgery if the results are not predictable.
Treatment :
Number of treatment options is available for failed back surgery syndrome. But the type of treatment or therapy depends on the intensity of pain and health condition of the patient. Some of the most widely used therapies are physiotherapy like stretching exercise, nerve block injections, antidepressants (for reducing pain sensation), pain pump, spinal cord stimulator, epidural injections (for cases of severe pain) and behavior modifications.
Stretching :
When the body is in the stages of healing process it is recommended that you can stretch the nerve root to prevent formation of epidural fibrosis. Most of the scar tissue will develop within few weeks of back surgery and hence if you could keep the nerve in regular movement position it will facilitate better healing of the injury. As long as there is movement of nerve while healing, it will not be bending down by adhesions or affected by the scar tissue. When you make stretching movement on your legs the large muscle of your thigh regions will press the nerve diagonally on the operative disc region in your lower back and thus prevents it from scarring.
Pain Caused by Scarring Tissue :
You have only limited treatment options for the pain caused by scarring tissue on the failed back surgery syndrome. Initially your doctor will prescribe you some drugs like neurontin for reducing the back pain and involve you in exercises after few weeks of operation. These techniques are useful for only limited period of treating pain. In case if the pain occurs years after the back surgery then it may not be caused due to scarring tissue. It can be due to other reasons like compression of the nerve or small disc herniation or growth of new bone near the nerve.
If the pain continues to be there during postoperative periods of surgery then it cannot be due to scar tissue and re-operating it second time will not going to fix the issue anymore. Hence it is necessary to probe into other possible causes of pain setting aside the scar tissue. In this regard total lumbar disc replacement surgery is still under debate whether it can provide permanent solution for fixing the problems caused by lumbar fusion.
Electrical Stimulation :
Chronic Pain can be managed by electrical stimulation therapy. For many patients there will be chronic pain on the back and legs during postoperative period. Failed back surgery syndrome can be treated by electrical nerve stimulation on the transcutaneuos region. A tiny device is placed on the back or for some people a nerve stimulator is implanted on the back region so that electrical impulse generated by it directly touches the spine.
Prevention :
The best way for preventing failed back surgery syndrome is to check whether the portion of injury or lesion that your surgeon will be operating is the actual source for causing pain. Analyze about the statistics of the success outcome for particular type of surgery before preparing for your operation. Make sure that this surgery will be best option available for resolving the underlying medical issue.
