What is Failed Back Syndrome?
Failed back syndrome (FBSS, or failed back surgery syndrome) is a generalized term that is which describes patients who have not had a successful result with back surgery or spine surgery and who continue to experience pain after surgery. Back surgery can be life changing but even with optimal conditions will only be successful about 95% of the time. Since pain cannot be seen, there can be no guarantee that surgery will eliminate the pain. Selection of the correct procedure is also paramount to get the best result from back surgery.
Symptoms of failed back syndrome are the same as the symptoms the patient had surgery for in the first place. Pain is the most common symptom which can be chronic, debilitating, sharp or dull. Regardless of the cause, the most common symptoms include neck or back pain and stiffness, numbness or tingling in the arms and neck and legs, weakness of the arms and legs, a burning sensation in the arms and legs, trouble with walking or difficulty with hand coordination.
Any surgery that does not control your symptoms of pain can be considered failed back surgery. Spinal surgery can only stabilize a painful back joint or decompress a nerve root or the spinal cord. Surgery cannot always remove pain. Back surgery can change back anatomy and correct the spine in the most likely area of back pain, but even a successful surgery can leave a patient with pain. Correct diagnosis as well as an appropriate surgery can prevent failed back syndrome in most but not all cases. The most common cause of failed back surgery is not operating on the problem causing the pain.
Diagnosis of failed back syndrome includes back pain after back surgery. This involves a combination of the patient’s history, examination and testing which may include:
- A complete physical and neurological exam which includes evaluation of loss of sensation, weakness and decreased or absent reflexes. A neurological deficit could help locate the area of cervical spinal compression. Also a review of the treatments and procedures the patient has already had is important.
- Imaging tests may include X-rays use radiation to look at the bony anatomy of your cervical spine and may be a first test used. Magnetic resonance imaging (MRI) uses powerful magnets to evaluate the structure of the spinal cord and spinal verves. Computed tomography (CT) scans use X-rays and are excellent for evaluating bony anatomy or acute bleeding of the spinal cord.
A Myelogram uses a special dye injected into the spinal fluid and an X-ray or CT scan to better look at the spinal cord. EMG or electromyography tests the health of muscles and the nerves that serve them.
Proper diagnosis is paramount with both primary back surgery as well as the secondary back surgery of failed back syndrome. Your care will depend on the severity and causes of your symptoms. Conservative treatments include nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease pain and swelling, and steroid injections that reduce swelling. Heat or cold like an ice bag, heating pad, or hot shower can help reduce pain. Physical therapy can involve muscle strengthening exercises or training in how to control your cervical spine more safely. A cervical collar or back brace might be used to support your spinal cord while limiting movement.
An additional surgery may be indicated where there is chronic and severe pain that is not relieved by conservative treatment. Surgical treatments may include removing bone spurs or portions of the cervical spine to widen the space between vertebrae. Surgery will also relieve pain much more rapidly than rest and medication. Connecting some of the vertebrae together can stabilize an area of the spine using metal rods and bone grafts. Surgeries include one or a combination of the following procedures:
- Laminectomy or laminotomy– your surgeon uses a microscope to make a small opening in the spinal bone (vertebral arch) to relieve pressure on the nerve roots.
- Discectomy or microdiscectomy– the most common bulging disc surgery in the lumbar region involves removing all or a portion of the bulging disc that is pressing on your nerve root. A microdiscectomy uses smaller instruments which are less invasive and can be an outpatient procedure. A discectomy for leg pain will very predictably reduce pain while a discectomy for back pain is less likely to be successful.
- Artificial disc surgery– is used when only a single disc in the lower back is involved and you do not have widespread arthritis or osteoporosis. An abdominal incision is used to approach the spine and an artificial disc replaces the bulging disc. This requires general anesthesia and generally a short hospital stay.
- Spinal fusion– two of more of the spinal vertebrae are permanently attached together using bone grafts with plastic or metal screws and rods. This permanently fuses the spine vertebrae in the attached segments. This also requires general anesthesia and a short hospital stay. Spin fusion for spinal instability has excellent predictive results while spinal fusion for multi-level degenerative disc disease is generally less effective for pain reduction.
The best way to manage your failed back syndrome is to educate yourself as much as you can regarding your condition, and to become involved in your own care and treatment with your healthcare providers. Keeping your back as healthy as possible includes having a healthy weight, good posture, proper lifting techniques, and regular exercise.
The neurosurgeons of Norelle Health are highly trained and skilled in the diagnosis, management, and treatment of failed back syndrome. Our neurosurgeons can provide the optimal treatment. Neurosurgery is considered essential by insurances and should be covered with your plan. As out-of-network providers, we will check your benefits for you and let you know what they are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us (link to contact page) or call our office (link to phone number).