FAQs on Failed Back Surgery Syndrome in Houston

What is Failed Back Surgery Syndrome (FBSS)?

FBSS is a term used to describe the condition of patients who have had a failed spine surgery that didn’t produce the desired results. As a result, some patients experience endless, excruciating pain that just does not go away. For some patients, the pain may keep going and coming back, adversely affecting their quality of life.

What are the symptoms?

Patients with FBSS may experience:

  • Limited mobility
  • Pain around the treated area of spine
  • Persistent/chronic pain
  • Inability to recuperate
  • Joint immobility
  • Sharp pain in extremities
  • Dull or severe pain in the back, neck, or legs
  • Spasms
  • Depression/anxiety

What are the causes?

There are primarily three categories of failed back surgeries.

  • First, patients who have undergone back surgery for the wrong reason, meaning that the surgery wasn’t required at all.
  • Second, patients who have had surgery that wasn’t performed well or done very well; however, the desired outcome could not be achieved.
  • Third, a back surgery can fail over a period of time. Degeneration may occur in the area surgery was performed.

FDA’s 2004 clinical trial performed to look at artificial disc replacement is a recent example of failed back surgery. The study found that 50% of artificial disc replacement patients had to continue with narcotic medication therapy for more than one year after surgery for pain control. This shows that a back surgery, even though performed for the right reasons, doesn’t give a pain-free outcome.

Scar Tissue

Scar tissue formation around nerve roots is the outcome of a spinal fusion procedure. Not only this, it can cause other changes inside the nerve root, resulting in significant leg pain and requiring medication therapy to relieve pain.

Other Reasons for Failed Back Surgery Syndrome

Many other factors can contribute to a failed spinal surgery, which may include:

  • Incorrect diagnosis
  • Unnecessary surgery
  • Surgery performed at the wrong site
  • Incorrect insertion of hardware
  • Spinal fusion failure
  • Nerve damage
  • Unrealistic expectations
  • Iatrogenic complications
  • Failure to properly treat the condition
  • Poor decompression of nerve root or spinal stenosis
  • Creation of new spine conditions at a site other than the operated one

Adjacent segment degeneration is commonly found to be the reason patients experience accelerated degeneration pain after an initially successful spine surgery. Over 20% of people who have had a spinal fusion are at the risk of requiring revision surgery within the next decade due to adjacent segment degeneration.

How is FBSS diagnosed?

Appropriate medical history, physical exam, and radiographic and neurodiagnostic evaluation help a doctor evaluate the patient’s potential source of problem. Patients with failed back surgery are carefully assessed to find the real cause of symptoms and effects on their emotional and functional state.

The first thing a Houston pain doctor will ask is the patient’s history of back fusion surgery. For proper diagnosis, it’s important that the patient gives a clear explanation of their symptoms before and after surgery. The doctor may be interested to know about midline or diffuse back pain symptoms and ask if they have been experiencing persistence of original back pain, which potentially has gotten worse after the surgery.

In most cases, the pain management doctor in Houston will use different tests and technologies, including magnetic resonance imaging, X-rays, electromyography to measure impulses within muscles, diagnostic block, nerve conduction velocity, and X-ray guided spinal injection diagnostics.

What are the treatment options for Failed Back Surgery Syndrome?

A failed surgery not only results in severe pain, but also creates several social, psychological, or vocational problems that aren’t directly related to the pain. Before recommending any treatment, the doctor tries to find the root cause of the problem, as the syndrome is associated with different causes. The reason for persistent pain could be that the hardware broke under constant stress and the fusion never occurred. A CT scan or X-ray could help detect this problem.

Initially, some doctors start with conservative treatment measures, including pain management, rehabilitation, chiropractic, physical therapy, exercise, or spinal cord stimulators, before suggesting a revision surgery.

Traditional treatment includes:

  • Spinal cord stimulator
  • Narcotics
  • Comprehensive protherapy
  • Intravenous lidocaine infusions
  • Anti-convulsants
  • Intrathecal Drug Delivery with implantable pain pump
  • Epidural steroid injections
  • Tricyclic antidepressants
  • Revision surgeries
  • Mind over body pain control
  • Chronic opiate management

For people who had a good result initially and then begin to experience persistent leg pain, the Houston pain doctor will try to find whether it is from a herniated disc or scar tissue formation.

For failed back surgery cases, where revision surgery is not preferred, the treatment should begin with over-the-counter pain medications. The medication therapy often includes some anti-inflammatories and Tylenol. Long-term narcotic prescription drugs may be required to alleviate chronic pain symptoms.

In addition to medication management, physical therapy, ice and heat therapy, chiropractic treatment, ultrasound, and electrical stimulation are some other treatment alternatives to manage pain. Massage is an effective therapy to disintegrate some scar tissue, which relieves pain to some extent.

Interventional treatments, including facet blocks, trigger point injections, epidural steroid injections, and numbing pain medicine injections around painful hardware, may offer maximum benefit from pain and other symptoms.

Spinal cord stimulation should be the last resort for patients of failed back surgery syndrome when no other treatments work. The stimulators alter the way your brain perceives pain signals, masking and converting pain into a tingling sensation.

It is unreasonable to expect that your back pain from a failed spine surgery will vanish completely with the given treatment alternatives, which can help alleviate the pain to a great extent. This could make it possible for you to perform daily activities that you had been performing before the surgery.

http://iuhealth.org/pain-management/failed-back-surgery-syndrome/

http://www.spine-health.com/treatment/back-surgery/causes-failed-back-surgery-syndrome

http://www.orthochirurg.com/resources/journals/FAILED%20BACK%20SURGERY%20SYNDROME%20DIAGNOSTIC%20EVALUATION.pdf