Failed Back Surgery Syndrome
Failed back surgery syndrome describes continued pain following one or more spinal surgeries. The term is controversial as some believe it is not a diagnosis. It unfortunately involves younger patients and numbers in the thousands per year. Risks factors in developing failed back surgery syndrome include a history of anxiety or depression. Of course poor technical planning such as poor patient selection, an inappropriate surgical procedure, incorrect diagnosis can also be a factor. Unfortunately further surgery is often not the solution. There are many potential areas in the spine that cause pain. Occasionally, the location of the pain is difficult to identify, but surgery is done with the expectation that it will resolve the problem. If the surgery is not successful then it can be considered failed back surgery syndrome but in reality it just means that the surgery was not successful and another search for the location of the pain needs to be started. Sometimes scar tissue forms and starts to compress the spinal nerve as well. This condition is known as arachnoiditis and surgery is usually not considered for this diagnosis. Sometimes a disc herniation may also recur.
• Pain radiating down the arm or leg
• Pain with leg extension
• Arm or leg weakness
• Arm or leg numbness
• Progressive pain and in some cases disability
• One to six months of pain-free status suggests the development of arachnoiditis and is more common with more than one lumbar spine surgery
• Greater than six months of pain-free status suggests a recurrent disc herniation
Other diseases that can mimic a disc herniation include:
• Shoulder osteoarthritis
• Hip osteoarthritis
• Sacroiliac joint dysfunction
• Spinal stenosis • Adjacent level disease
• Inadequate surgical disc decompression
• Inadequate fusion
• Recurrent disc herniation
• Spinal instability
Treatment will depend on the source of pain. For less severe pain a course of nonsteroidal anti-inflammatory medicines (NSAIDs) and physical therapy may be helpful. For more severe pain innovated procedures such as epidural steroid injections, lysis of adhesions or a spinal cord stimulator may be helpful.
Hazard RG. Failed back surgery syndrome: surgical and nonsurgical approaches. Clin Orthop Relat Res. 2006 Feb;443:228-32.
Panagos A. Rehabilitation Medicine Quick Reference-Spine (ed. Buschbacher R.M.) New York: Demos Publishing; 2010. p. 70-71.