What You Need to Know About Failed Back Surgery Syndrome

After spine surgery, you expect your back or neck problem to be resolved. But, sometimes, that doesn’t happen. Whether immediately or months after your procedure, pain and other symptoms may return—a phenomenon known as failed back surgery (FBS). Also called failed back surgery syndrome (FBSS) and post-laminectomy syndrome, FBS can affect any level of your spine, and it can be a frustrating experience for patients and surgeons alike.

post-operative lumbar spine, instrumentation, fusionSuspecting or being diagnosed with failed back surgery raises many questions for patients and surgeons. Things patients need to now about failed back surgery. Photo Source: 123RF.com.

Does this Mean My Spine Surgery Failed?

If your doctor diagnoses you with failed back surgery or FBSS, it’s natural to assume that your surgery “failed,” based on the condition name alone. However, that’s not always the case. In truth, the name, failed back surgery or failed back surgery syndrome is inaccurate and confusing. Having failed back surgery doesn’t suggest that you or your surgeon have failed. Many factors that lead to FBS are out of your control.

What Is Failed Back Surgery?

Simply put, failed back surgery means you have persistent back or neck pain after spine surgery. In other words, your and your surgeon’s expected surgery outcome—that your spine pain would be minimized or eliminated—didn’t happen.

In addition to chronic back pain, other symptoms of failed back surgery include neurological symptoms (eg, numbness, weakness, tingling sensations), leg pain, and radicular pain (pain that spreads from one area of the body to another, such as from your neck down to your arm).

In addition to reducing your pain, you may have expected spine surgery to impact other facets of your life. Improving your function, quality of life, and ease of daily activities all impact the definition of surgery success. Understanding how your life looks after surgery will help your doctor understand whether your pain is related to FBS.

To be diagnosed with FBS, your doctor must be able to link your current spinal problem to your previous spinal surgery. For example: If you now have back pain 5 years after your spine surgery, your doctor may find that the cause of your new pain is wear and tear on your spine due to aging (eg, degenerative changes), not your previous surgery.

Failed Back Surgery: What the Numbers Tell Us

Researchers believe that failed back surgery occurs in anywhere between 10% to 40% of lumbar laminectomy surgeries (with or without spinal fusion).1 Other studies show that 5% to 36% of people who undergo a discectomy for a lumbar herniated disc saw their leg and back pain return just 2 years after surgery.2

And with a growing aging population, the number of spine surgeries is increasing—and that means the number of FBS cases is also growing. Between 1998 and 2008, the annual lumbar fusion rate skyrocketed by 170.9%, and the laminectomy rate jumped 11.3% during the same period.2

But more surgeries don’t always deliver better results, especially when you look at the recurrent surgery rate. With each spine surgery you have, the chance of success drops:

  • 50% success rate after the first repeat surgery
  • 30% after the second
  • 15% after the third
  • 5% after the fourth3

That’s why surgery isn’t always the answer after failed back surgery. Instead, your doctor may turn to non-surgical therapies to manage FBS.

Risk Factors That Increase Your Chances of Failed Back Surgery Syndrome

Several factors may influence whether you have failed back surgery syndrome after your spine surgery, and they may occur before your surgery (pre-operative), during your surgery (intraoperative), and after your surgery (post-operative).

Pre-operative FBS risk factors
The risk factors below shouldn’t prevent a patient from undergoing spine surgery; however, adequately addressing these issues before surgery will increase the chance of success.

Patient-related pre-operative FBS risk factors include:

  • Presence of mental and emotional disorders (eg, depression, anxiety)
  • Surgery is tied to a workers’ compensation case or other legal issue
  • Obesity
  • Smoking (eg, tobacco use)
  • Patients with chronic pain related to other conditions such as fibromyalgia

Surgeon-related pre-operative risk factors include:

  • Poor patient selection, choosing a patient who has no chance of improving with surgery
  • Poor surgical planning

Intraoperative FBS risk factors
During surgery, the following factors may lead to failed back surgery syndrome:

  • Failing to create enough space around spinal nerves/spinal cord (inadequate decompression)
  • Creating too much space around nerves, which may lead to spinal instability (excessive decompression)
  • Surgery performed at the wrong level (incorrect surgery), which occurs in about 2.1%–2.7% of cases and is more common in minimally invasive surgeries.1

Post-operative FBS risk factors
After surgery, the following factors may cause or contribute to failed back surgery:

  • Recurrent original diagnosis (eg, recurrent disc herniation at the same site or at a nearby level)
  • Adjacent segment disease (ASD) after spinal fusion where the level above a fusion has increased stress and therefore can degenerate in an accelerated fashion
  • Epidural fibrosis (when nerve roots are trapped by scar tissue)
  • Spinal infection
  • Spinal balance-related issues (sagittal imbalance), which can accelerate degeneration
  • Spinal nerve root irritation, which can cause radiating pain after surgery
  • Pseudoarthrosis, lack of fusion which results in loosening of the screws

Treatments That May Improve Your Quality of Life After Failed Back Surgery

Learning your spine surgery did not produce the outcomes you expected can be extremely disappointing, but therapies may help reduce your pain and restore your ability to function in everyday life. Not all patient pain complaints can be fixed with spine surgery.

Your doctor may use a multidisciplinary approach to address your pain: This means that instead of relying on one treatment (eg, medications or surgery), he or she may recommend a mix of therapies that comprehensively address different facets of your pain. Your doctor may refer you to a physical therapist to restore function and/or a behavioral health professional to address mental and emotional health. Your doctor may prescribe medications to help you manage pain, or you may be a candidate for spinal cord stimulation. Regardless of the treatments used, they will be catered to you and give you the best chance for recovery.

Continue Reading ... Failed Back Surgery Syndrome Symptoms

References:
1. Sebaaly A, Lahoud MJ, Rizkallah M, Kreichati G, Kharrat K. Etiology, evaluation, and treatment of failed back surgery syndrome. Asian Spine J. 2018;12:574–85. doi: 10.4184/asj.2018.12.3.574.

2. Baber Z, Erdek MA. Failed back surgery syndrome: current perspectives. J Pain Res. 2016;9:979–87. doi: 10.2147/JPR.S92776.

3. Micheo WF, Sepúlveda FL, Amill R. Post-Laminectomy Pain. https://now.aapmr.org/post-laminectomy-pain/. Published August 30, 2013. Last updated February 21, 2018. Accessed January 11, 2019.

Sources:
Micheo WF, Sepúlveda FL, Amill R. Post-Laminectomy Pain. https://now.aapmr.org/post-laminectomy-pain/. Published August 30, 2013. Last updated February 21, 2018. Accessed January 11, 2019.

Baber Z, Erdek MA. Failed back surgery syndrome: current perspectives. J Pain Res. 2016;9:979–87. doi: 10.2147/JPR.S92776.

Sebaaly A, Lahoud MJ, Rizkallah M, Kreichati G, Kharrat K. Etiology, evaluation, and treatment of failed back surgery syndrome. Asian Spine J. 2018;12:574–85. doi: 10.4184/asj.2018.12.3.574.

Daniell JR, Osti OL. Failed Back Surgery Syndrome: A Review Article. Asian Spine J. 2018; 12(2): 372–379. Published online April 16, 2018. doi:[10.4184/asj.2018.12.2.372].

Ragab A, Deshazo RD. Management of Back Pain in Patients with Previous Back Surgery. Am J Med. 2008;121(4):272-278. doi:10.1016/j.amjmed.2008.01.004.

Inoue S, Kamiya M, Nishihara M, Arai YP, Ikemoto T, Ushida T. Prevalence, characteristics, and burden of failed back surgery syndrome: the influence of various residual symptoms on patient satisfaction and quality of life as assessed by a nationwide Internet survey in Japan. J Pain Res. 2017; 10: 811–823. Published online April 6, 2017. doi: [10.2147/JPR.S129295].

Updated on: 02/07/19
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