How to diagnose failed back surgery syndrome?
Summary of background data: Treatments for FBSS may be generally categorized as physical therapy and exercise, medications, interventional procedures, neuromodulation, and reoperation. Careful review and classification of the level of evidence available for each category of treatment for FBSS patients will help guide clinical decision-making.
What to do after a failed back surgery?
Jul 15, 2017 · Key Points Clinicians may better treat Failed Back Surgery Syndrome (FBSS) patients armed with the level of evidence available for... The weakest level of evidence for the treatment of FBSS is in medication management and reoperation. The strongest level of evidence is in active exercise, some ...
How can I avoid failed back surgery syndrome?
Nov 27, 2021 · There is limited evidence for oral opioids in the treatment of chronic low back pain; however, their routine use is widespread Steroids are only effective in a minority of patients with failed back surgery syndrome Research shows effective treatment options for failed back surgery syndrome beyond ...
What are the symptoms of failed back surgery syndrome?
Jun 20, 2021 · Thus, failed back surgery syndrome is a syndrome with many causative etiologies and marked heterogeneity among patients. Despite its debilitating effect on patients and relative prevalence among the population receiving back surgery, few high-quality randomized trials exist investigating treatment for FBSS.
Can failed back surgery syndrome be cured?
Not all surgeries carry the moniker after a procedure doesn't cure or alleviate a condition. Failed back surgery syndrome, though, is very real for patients who undergo a procedure on their spine yet still endure pain in their lower back or legs. If this happens, don't be discouraged.Apr 20, 2021
What happens when back surgery doesn't work?
If the bone doesn't actually knit together, the screws and rods will predictably work themselves loose over time, or even break. Once this happens, patients may develop either new back pain or recurrent leg symptoms. The other big category is that of continued degeneration at a level next to a previous surgery.Sep 5, 2018
What can be done for a failed spinal fusion?
In most cases this will require a new fusion, but some patients can be converted to a motion procedure. Surgeons might also opt to use a bone morphogenetic protein (BMP) the second time around.Aug 29, 2019
What is failed back surgery called?
Failed back surgery syndrome (also called FBSS, or failed back syndrome) is a misnomer, as it is not actually a syndrome - it is a very generalized term that is often used to describe the condition of patients who have not had a successful result with back surgery or spine surgery and have experienced continued pain ...
How common is failed back surgery syndrome?
While published reports estimate the incidence of failed back surgery syndrome to be between 20 – 40%, the likelihood is considered greater with repeated surgery, and the condition will be more prevalent in regions where spinal surgery is more common.Nov 22, 2021
Why does back surgery fail?
Improper preoperative patient selection before back surgery. This is the most common cause of failed back surgery syndrome. Surgeons look for an anatomic lesion in the spine that they can correlate with a patients pain pattern. Some lesions are more reliable than others.
Why does spinal fusion surgery fail?
Implant Failure in Spine Surgery An instrumented fusion can fail if there is not enough support to hold the spine while it is fusing. Therefore, spinal hardware (e.g. pedicle screws) may be used as an internal splint to hold the spine while it fuses after spine surgery.
Can a discectomy fail?
Although pain of any kind is considered “failed microdiscectomy” even if the surgery was otherwise a success, most of the causes of pain after microdiscectomy are directly related to the procedure itself, including: Dural Tears. Insufficient Bone Removal. Recurrent Disc Herniation.
Can you have a second spinal fusion?
A two-level fusion may be considered for patients with severe, disabling pain that occurs at two levels of the spine (e.g. L4-L5 and L5-S1), but only after extensive non-surgical and pain management approaches have been tried.
What happens if a laminectomy doesn't work?
TREATMENT FOR FAILED LAMINECTOMY If the patient underwent a laminectomy, and the pain returned, treatment requires a thorough diagnosis to determine any structural changes or deficits that may have contributed to the pain. If any are found, a follow up revision spine surgery may be recommended, such as spinal fusion.
What happens when a laminectomy fails?
In some cases, despite performing a laminectomy, patients experience pain because the spinal column itself is narrowed in a condition called spinal stenosis. Sometimes, there may be a small fragment of the disc still remaining following the laminectomy which can irritate the spinal-cord causing pain.
How long does post laminectomy syndrome last?
Another trial found SCS effectively helped control pain in 62 of 116 patients with pain in the back and lower extremities (of these, 56 exhibited post laminectomy syndrome) over follow-up periods ranging from 6 months to 10 years, with a mean follow-up period of 40 months (Kumar et al, 1991).Jan 13, 2022
What is the treatment for FBSS?
Treatments for FBSS may be generally categorized as physical therapy and exercise, medications, interventional procedures, neuromodulation, and reoperation. Careful review and classification of the level of evidence available for each category of treatment for FBSS patients will help guide clinical decision-making.
How long does lumbar spine surgery last?
Although technical innovations continue, the rate of success of lumbar spine surgery is only marginally better than conventional medical management (CMM) after 1 year and similar to CMM after 2 years. 1.
Why is evidence based approach important for FBSS?
Using an evidence-based approach to evaluate FBSS treatments will assist clinicians in choosing the most effective options for FBSS patients. Furthermore, reducing the utilization of less effective therapies may result in substantial financial savings for this patient population.
Is exercise therapy a level 1 study?
The evidence for exercise, rehabilitation, manipulation, and behavioral therapy was moderate with no Level I studies in the peer-reviewed literature. There were three Level II studies and one systematic review ( Table 1 ).
Is neuromodulation better than IDDS?
Neuromodulation, including SCS and IDDS, may offer more effective, safer long-term pain management for FBSS patients, especially in light of the recent call by The Centers for Disease Control and Prevention (CDC) to lessen dependence on chronic opioid therapy for chronic pain. 95 As SCS has fewer complications and no medication-related side effects, 83 it is usually the preferred over IDDS; however, both may be more effective than systemic medications. 74,75,85,86 A significant advantage of both SCS and IDDS is the option to trial the therapy for several days with a simple percutaneous needle delivery of electrodes (SCS) or a catheter (IDDS) before undertaking a permanent implant.
Is FBSS a confounding factor?
FBSS has many sub-etiologies, often overlapping, so it is difficult to control for confounding factors. Many patients suffer adjacent level disease of either discogenic or facetogenic origin, 94 recurrent or persistent neural compressive disease, 7 neuritis, fibrosis, deafferentation, 14 and hardware pain, not to mention centralization of pain syndromes layered on the bio-psychosocial nature of failed surgeries and disability. 25
What to do after back surgery?
After a failed back surgery, most clinicians will recommend conservative management once again, given the risks of subsequent surgery. Nonoperative management after spine surgery is aimed at strengthening the patient’s core and increasing the spine’s range of motion. That means physical therapy.
What is a failed back?
Failed back syndrome is the term for pain that persists even after surgery. It does not necessarily mean that the surgery was botched; more likely, it was ineffective.
How long does it take for back pain to resolve?
Many cases of back pain resolve themselves in a matter of weeks or months, so conservative treatment is usually the recommended initial therapy. Conservative treatment can include: Rest. Activity modification. Nonsteroidal anti-inflammatory medications (NSAIDs) Corticosteroid injections. Physical therapy.
What happens after a discectomy?
Another common scenario happens after a discectomy or laminectomy to relieve symptoms of a herniated disc when the patient has degenerative disc disease (DDD). The surgery may have been performed flawlessly, but DDD can affect multiple locations in the spinal column.
Can a herniated disc be repaired?
Sometimes patients have one disc herniation repaired only to find that another herniation has occurred after recovery from the surgery, or a more minor existing herniation was being masked by stronger symptoms, which the surgery addressed. The risk for failed back syndrome rises with each surgery.
Is spinal cord stimulation effective?
Research suggests that spinal cord stimulation is an effective management technique for people with intractable radiculopathy who have already attempted surgery. A 2014 study examined data from more than 16,000 people with failed back syndrome. A small subset of those underwent spinal cord stimulator implantation.
Can a spinal fusion cause back pain?
It is also known as post-laminectomy syndrome (although it can also happen after a spinal fusion as well) and failed back surgery syndrome. Not only does your back still hurt, but also you feel like you’re right back where you started. But don’t lose hope.
How does prolotherapy help with back pain?
Prolotherapy can help many people who have failed back surgery by addressing spinal instability and repairing loose, lax, damaged ligaments. The key to successful treatment is identifying the right candidates. These treatments will not help everyone.
Why does my spine hurt after surgery?
This is discussed at length below. Generally speaking, spinal pain that occurs right after surgery is from sensitized nerves, while chronic post-surgical spinal pain is often from spinal instability, but, can have many different causes.
What is the procedure to remove a disc?
Discectomy. In a discectomy (removal of the disc), the surgeon must spread muscle and cut various ligaments in order to perform the surgery. The surgery itself can potentially lead to ligament laxity and spinal instability. Sometimes this leads to an “immediate failure,” of the back surgery.
How does a spinal pump work?
Similar to a spinal cord stimulator, spinal drug delivery (or intrathecal drug delivery) involves implanting a small pump in the stomach and running a catheter to the spine to deliver pain medication. It is used for people with chronic back pain who need large doses of narcotics to deal with the pain. Compared to oral medication, this “pain pump” requires a smaller dose of narcotics because the medication goes directly to the area of pain.
Can you have back pain after spinal surgery?
Moving forward may be difficult for you as your pain can be significant or bothersome and it is compromising your quality of life. Although your back pain may not be as severe as it was before the surgery, you like many will continue to experience significant back pain after spinal surgery.
What is spinal cord stimulation?
Spinal cord stimulation is usually reserved as a last-chance effort at controlling back pain. Specifically, it is used for people who have pain after surgery, complex regional pain syndrome, or severe nerve pain and numbness.
Can a laminectomy cause spinal instability?
The parts of the spine immediately above and below the surgery site. Laminectomy in the lower back, thoracic region, or neck can cause or lead to spinal instability. The thoracic spine is especially vulnerable to clinical instability after a laminectomy because it normally has a physiologic kyphosis (a curvature).
What is FBSS in medical terms?
Failed back surgery syndrome (FBSS) is defined by the International Association for the Study of Pain as “lumbar spinal pain of unknown origin either persisting despite surgical intervention or appearing after surgical intervention for spinal pain originally in the same topographical location.”. The pain may originate after surgery, or ...
Can back surgery cause pain?
The pain may originate after surgery, or the surgery may exacerbate or insufficiently ameliorate existing pain. Thus, failed back surgery syndrome is a syndrome with many causative etiologies and marked heterogeneity among patients.
When a patient comes to you and their surgery was not successful, what do you do?
Dr. Rashbaum: We find out what went wrong. Typically, the patients I see that clearly have failed back surgery syndrome (FBSS) go back to their doctor, only to find that their doctors are totally disengaged in finding the truth. Unfortunately, this is common.
Once you find out what went wrong, what are the next steps?
Dr. Rashbaum: Sometimes we’ll do injection therapy to help us figure out where the pain is coming from. We need to determine if the pain now is mechanical facet joint pain, mechanical disc degeneration, or painful disc syndrome. Above all, we don’t give up on these patients.
Do many of these patients need to undergo revision surgery?
Dr. Rashbaum: What you’re asking is what percentage of FBSS patients could undergo a second surgery and recover with improvement. I hate to say this, but the number of those people that are likely to successfully recover from a second surgery, let alone a third, is not great.
What does the data show regarding the success rate of spinal cord stimulation?
Dr. Rashbaum: Studies both in Canada and in the United States indicate that the satisfaction and benefit rate of patients with failed back surgery syndrome initially implanted with a spinal cord stimulator were statistically better than patients who underwent revision surgery.
What happens if you don't knit your bones together?
If the bone doesn’t actually knit together, the screws and rods will predictably work themselves loose over time, or even break. Once this happens, patients may develop either new back pain or recurrent leg symptoms. The other big category is that of continued degeneration at a level next to a previous surgery.
Can back pain be a disability?
You often now may RSVP no, because you don’t want to deal with the discomfort. Nearly one in 10 people experience lower back pain, causing more disability than any other condition in the world.
Can back surgery cause pain?
Failed Back Surgery Syndrome: When The Pain Comes Back After Surgery. From a constant, dull ache to a stabbing or shooting sensation, back pain can show up like an out-of-town relative — sometimes it’s just annoying; other times it’s unbearable. Back pain can also hurt more than just your body.
