Is a Revision Spine Operation After Failed Back Surgery Right for Me?

Failed back surgery—which your doctor may also call failed back surgery syndrome, FBSS, FBS, and post-laminectomy syndrome—is a complex condition, and your doctor has several treatment options to help ease your lumbar spine (low back) and/or leg pain. Depending on your specific situation, your doctor may recommend a revision, or second, surgery to treat your FBS.

Spine surgery bears risks and potential complications—and, as you know, it’s not a guaranteed fix for your back pain. Before pursuing this treatment option, it’s important you and your doctor align expectations and communicate clearly.
X-ray image of 3 discs highlighted in red, indicating pain.Back pain is the foremost symptom of failed back surgery syndrome. Photo Source:

Why Your Doctor May First Recommend Non-Surgical Treatment for Failed Back Surgery

Your doctor will most likely first recommend non-surgical treatments (eg, exercise or radiofrequency ablation) to treat your failed back surgery symptoms. Some people may be confused by this approach: Why would I go back to conservative treatment when I needed spine surgery before?

The reason non-surgical treatments should be tried is that surgery is considered a last resort. There are risks to any surgery. With each spine surgery you have, the success rate drops. While more than half of first spine surgeries are successful, no more than 30% of second surgeries are successful. The success rates of third and fourth spine surgeries are even lower—no more than 15% and 5%, respectively.1

But that doesn’t mean you should be concerned if your doctor deems you a candidate for a second spine surgery after FBS. Revision surgery is an appropriate treatment for certain serious conditions, which you’ll learn about below.

When Is a Revision Back Surgery Considered After FBS?

In most cases, your doctor will have you try several non-surgical treatments to treat your symptoms related to FBS before discussing the option of a revision back surgery—that is, if spine surgery is reasonable and appropriate. If your doctor agrees to pursue a second spine surgery to treat your back and/or leg pain, he or she may ask that you undergo a pre-surgical psychological evaluation. Don’t be offended or alarmed if your doctor asks you to undergo this evaluation: It is intended to help you clearly understand the risks of surgery, assess your readiness to undergo a second procedure, and suggest pre-surgical treatment intervention for mental and emotional disorders (if necessary).

Although first trying non-surgical treatment is standard, your doctor may recommend immediate spine surgery if you present with any of the potentially serious spinal conditions below:

  • You have new and significant nerve-related (neurologic) problem(s), such as weakness, shooting pain, and numbness. As it relates to the lumbar spine, bowel and bladder dysfunction is a major cause for concern. Another rare low back neurologic condition—cauda equina syndrome—may also require urgent spine surgery.
  • You have spinal instability or pseudoarthrosis (a fusion that fails to heal as it should), which makes it clearer why you have ongoing symptoms.
  • You have moved or broken spinal instrumentation that threatens to damage nerve and/or vascular structures.
  • You have a spinal infection.

Other spinal problems and conditions that present after your first surgery that may warrant a revision lumbar spine procedure include:

  • You received a new spinal diagnosis (ie, a different diagnosis than your initial low back surgery).
  • Your original spinal diagnosis has returned.
  • Your first back surgery didn’t adequately decompress your spinal nerves.
  • Your first back surgery led to the formation of adjacent segment disease.
  • Your first back surgery led to the formation of scar tissue problems that are impinging on your spinal nerves (such as epidural fibrosus).

What Are the Goals of a Second Surgery After Failed Back Surgery Syndrome?

While your revision back surgery will treat the underlying spinal problem related to your failed back surgery (eg, removing problematic scar tissue), the ultimate goals of surgery can be boiled down to 2 categories:

  1. Decompression
  2. Stabilization
  3. Both

Decompression lumbar spine surgery in a nutshell
As the name suggests, decompression surgery aims to decompress cramped spinal nerves. If you have nerve pain after your first back surgery, your surgeon will use a decompressive approach to ease that type of pain by removing the compressing structure (eg, a bone spur) or widening the area immediately surrounding the irritated nerve root.

Examples of decompression surgeries commonly performed in the low back include:

  • Discectomy
  • Foraminotomy
  • Laminotomy and laminectomy

But decompression surgery can create a problem: It can lead to spinal instability when it removes structures (eg, bone) to create additional space.  Decompression is specifically used to treat symptoms related to nerve impingement and therefore radicular pain or pain going down the leg. This additional space may allow spinal bones (vertebrae) to move more than they should, making your spine unstable. If a decompression threatens the stability of your spine, your surgeon will also perform a stabilization procedure after the decompression during the same surgery.

Stabilization lumbar spine surgery in a nutshell
Stabilization spine surgery, such as a lumbar spinal fusion, limits abnormal motion between vertebrae. If your lumbar spine vertebrae move too much or move out of place (eg, spondylolisthesis), it can cause significant nerve impairment. By fusing 2 or more vertebrae together, spinal fusion can help ensure that the bones do not compress nearby spinal nerves and/or your spinal cord. Getting separate vertebrae to grow together takes time to heal, so your surgeon may also implant spinal instrumentation (eg, screws and rods) to support the fusion and bone graft to stimulate bone fusion. Stabilization is generally used to treat pain localized to the back as opposed to radicular pain treated with decompression. Sometimes, use of a bone growth stimulator is recommended for use during post-operative recovery to stimulate new bone growth necessary for spinal fusion.

Hospital or Outpatient Facility? Options for Where to Get Revision Spine Surgery

Nowadays, you may have options as to where you have your revision back surgery performed. If your spine surgeon works out of more than one facility, ask which location offers the best success rates for revision procedures after failed back surgery.

Convenience and comfort may also play a big role to you. If your doctor allows it, ask if having your revision back surgery at an outpatient spine center or ambulatory surgery center (ASC) is a possibility. Thanks to advancements in the spinal field, these facilities deliver excellent patient care and minimally invasive approaches in a convenient setting—many patients may go home the same day as their surgery. Patients with more complex medical problems or surgeries still require a hospital setting where other medical services are available to treat complications.

Talk to your doctor about the benefits and drawbacks of having your revision back surgery at hospital versus an outpatient setting, including what post-operative pain management is offered at each location.

How You Can Make Your Next Back Surgery a Success

When you’ve already experienced failed back surgery syndrome, you may wonder what you can do to improve your revision surgery’s chances of success. Some factors are out of your control, but one way to boost your outcomes is to be an engaged and informed patient. How do you accomplish that? Asking questions like the examples below before your procedure is a great place to start.

  • Are there any alternatives to traditional spine surgery that we haven’t yet considered for my condition (eg, spinal cord stimulation or minimally invasive spine surgery)?
  • What are the benefits and risks of this procedure?
  • What’s the success rate of my revision back surgery?
  • What risks do I face if I don’t have this procedure?

When you have a clear understanding of your spine procedure, you will feel more confident in your decision to undergo a revision surgery after failed back surgery (FBS). Knowing the risks and benefits as they relate to you will help you make a decision that supports your best interests.

Updated on: 02/12/19
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