Failed Back Surgery Syndrome (FBSS) is a general title given to pain and symptoms that occur when back surgery has been ineffective. A normal amount of pain and stiffness is expected post-operatively, as well as, soreness and muscle weakness for several weeks. In the case of spinal fusion, the body has to adjust to implants. Pain should subside after a few weeks; although, it may not completely go away. When symptoms do not subside or begin getting worse, then failed back surgery syndrome is suspected.

 

Failed Back Syndrome is not a single disease but a series of conditions that can emerge following any number of surgeries or treatments. It is characterized by diffuse pain that can be dull and aching to sharp, stabbing pain that radiates through the hip, buttocks, and legs.

 

Symptoms seen with Failed Back Surgery Syndrome include:

• persistent chronic pain
• inability to recuperate
• restricted mobility
• sharp, stabbing pain
• numbness or pain that radiates through the lower back or legs
• spasms
• anxiety
• depression
• disturbed sleep patterns

It is important to follow post-operative instructions because they are aimed at getting proper healing and at avoiding Failed Back Surgery Syndrome.

 

If  FBSS is suspected, the primary medical doctor should be contacted first and then the surgeon. They will develop a conservative treatment plan that includes stretching exercises, physical therapy, and pain medication. When the symptoms do not subside, there may be a recommendation for follow-up surgery.

 

The International Association for the Study of Pain defines FBSS as:

 

“lumbar spine pain of unknown origin either persisting despite surgical intervention or appear

            -ing after surgical intervention for spinal pain originally in the same topographical area.”

 

There are pre-operative and post-operative factors that can influence the outcome following back surgery.

 

Pre-operative factors include:

• litigation and dealings with workmen’s compensation
• smoking
• obesity
• pre-operative psychiatric mental health issues
• Etiology or history of the conditions

 

Post-operative factors include:

• a new onset of degenerative changes
• new or recurring disc herniation
• altered biomechanics that can lead to joint changes, muscular hypertrophy, atrophy, and spasms.

 

Diagnosis is primarily based on physical examination, as well as, CT, x-ray, MRI, diagnostic injection, discography, myelogram investigation.

 

Signs and symptoms that are considered definitive indicators include:

• changes in bowel and bladder function
• excessive motor weakness
• neural (nerve) deficit even with complete bed rest
• sciatica that worsens or becomes incapacitating despite bed rest
• instability in the spine
• problems with hardware such as screws or rods.

 

These symptoms may be caused by scar tissue around spinal roots that lead to tissue pain and muscle spasm. Failed Back Surgery Syndrome occurs in approximately 20 – 40 percent and the likelihood of it occurring increases with each successive surgery.