Failed Back Surgery Syndrome

About Failed Back Surgery Syndrome
Failed Back Syndrome is when patients fail to improve or worsen after spine surgery. These patients often continue to take pain medicine and are unable to return to work. Failed back syndrome is not one specific problem but a generalized term for people who did not do well.

The Cause
There are many causes for failed back syndrome including unrealistic expectations (they wanted to feel like they were twenty), incorrect diagnosis and treatment, correct diagnosis but wrong surgery or the problem was not properly fixed. There may be additional pain from a partially or unrecognized source. Bleeding, nerve damage or spinal leak may complicate surgery. A new problem may form after surgery such as disk herniation, blood clot, infection or scar tissue. Muscle damage or bone removal may lead to spinal weakness, instability and new pain. The prospect of loss of income, personal attention or returning to a poor work situation may hamper recovery.

Diagnosing Failed Back Surgery Syndrome
Patients with severe back and leg pains may have little abnormal findings on MRI scan and patients with no pain may have severe abnormalities. Therefore it can be difficult to determine the exact causes of the pain. A good history and physical examination, radiological tests and nerve studies identify most causes. The best outcome is when the person has typical symptoms (complaints), physical exam findings and MRI abnormalities. The less typical and more bizarre the complaints, the less likely the patient will benefit from surgery. If the exact cause cannot be identified or there are many possible causes then pain mapping may be beneficial pinpoint the cause of the pain.

Treatment for Failed Back Surgery Syndrome
The treatment depends on the cause of the pain. This can range from no treatment, physical therapy, pain medications, pain injections, spinal surgery, implantable morphine pumps and spinal cord stimulation. Common fixable causes of back and leg pain is recurrent disk herniation, spinal instability and foraminal stenosis (tightness around the nerve exiting the spine) and facet joint arthritis.
Recurrent disk herniations, foraminal stenosis and facet joint arthritis are difficult to treat with traditional surgery. Fortunately they are more easily treated with endoscopic spine surgery.