FAQS on Failed Back Surgery Syndrome in Nashville & Murfreesboro TN

Many patients who undergo back surgery end up suffering with failed back surgery syndrome (FBSS). This condition involves new or persistent pain after back surgery, which can occur in the back, buttocks, and/or legs. Published reports estimate that FBSS occurs in 20-40% of surgical cases, but the rate is probably higher with repeated surgery.

What is FBSS?

FBSS is not a syndrome, but a term used to describe a condition where patients suffer back pain and associated symptoms following spinal surgery. When surgery does not alleviate the spine problem, or creates a worse problem, the term failed back surgery syndrome is used to describe that patient’s symptoms and problems.

What causes FBSS?

Failed back surgery syndrome occurs as the result of several factors. This condition is rare following surgery of the cervical (neck) spine, but is quite common after lumbar (low back) spine surgery. The highest risk of developing FBSS occurs after open spinal fusion.

What factors contribute to failed back surgery syndrome?

Many factors contribute to FBSS development, such as:

  • Spinal fusion failure
  • Hardware insertion problems
  • Scar tissue formation
  • Development of a new spine condition after surgery
  • Nerve damage
  • Inadequate decompression of a nerve root
  • Missing fragment of bone or disc

What are the symptoms of FBSS?

Patients with FBSS have many symptoms. These include:

  • Pain above or below the surgical site
  • Limited mobility
  • Continued and chronic pain
  • Sharp, achy, stabbing pain in the extremities
  • Numbness, tingling, and/or weakness of the legs
  • Muscle spasms

What treatment options are available for FBSS?

Since failed back surgery syndrome is not a specific disorder, the doctor relies on history and symptoms to diagnose the condition. In addition, many diagnostic tests are used to rule out complications. Treatment options include:

  • Physical therapy – Because rehabilitation is important following any surgery, back surgery is no exception. With physical therapy, the patient learns exercises to strengthen back muscles, as well as stretching techniques to increase spine mobility and flexibility.
  • Epidural steroid injection (ESI) – Proven to have a 90% success rate, the ESI involves injecting a corticosteroid into the epidural space, which lies near the spinal cord. The long-acting steroid decreases inflammation and reduces pain.
  • Facet joint injection (FJI) – Often called a nerve block, these injections are usually given in a series of three. The doctor uses x-ray guidance to place tiny needles into the facet joints of the spine. A long-acting anesthetic is injected into the joint space onto the nerves, with or without a corticosteroid. FCIs offer moderate short- and long-term pain relief, according to a recent study.
  • Facet joint denervation (Radiofrequency Ablation) – Using x-ray guidance, the doctor will insert a small catheter into the facet joint. Once in position, a probe with a special device emits radiofrequency energy onto the back tissue, to coagulate and destroy the nerve roots near the spinal cord.
  • Transcutaneous electrical nerve stimulation (TENS) – This noninvasive approach to pain management is simple and effective, with a 70-95% success rate. Electrodes are placed on the skin near the spinal cord. A small device sends electrical impulses through the electrodes to the back, which interfere with pain sensations.
  • Spinal cord stimulation (SCS) – When other measures fail, the pain management specialist may recommend a spinal cord stimulator. This device is implanted near the spinal cord to deliver electrical current that interferes with pain signals.

Resources

De Ridder D, Plazier M, Menovsky T, Kamerling N, & Vanneste S (2013). Subcutaneous stimulation for failed back surgery syndrome: A case report. Neuromodulation.

Falco, FJ, Manchikanti, L, Datta, S, et al. (2012). An update of the effectiveness of therapeutic lumbar facet joint interventions. Pain Physician, 15(6), 909-953.

Gatchel RJ, Lou L, & Miller B (2004).Failed back syndrome. Pract Pain Manag, 4(3), 20-31.

Hills EC (2013). Mechanical low back pain. Retrieved from: http://emedicine.medscape.com/article/310353-overview

Hussain A & Erdek M (2014). Interventional pain management for failed back surgery syndrome. Pain Practice, 14(1), 64-78.

Jacques L, Jensen T, Rollins J, Burton B, Hakim R, & Miller S (2012). Decision memo for transcutaneous electrical nerve stimulation for chronic low back pain (CAG-00429N). tinyurl.com/ decisionmemoTENS

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Vital and Health Statistics. Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2009. Series 10: Data for the National Health Interview Survey. No. 249.