Failed back surgery syndrome is a term that describes a cluster of symptoms that are experienced after spinal surgeries. These spinal surgeries may often be done to correct conditions affecting the back, leg or other parts of the body. Sometimes, failed back surgery syndrome is caused by the condition that the surgery was supposed to resolve. In other cases, the surgery and other factors are directly responsible for the pain felt.
The pain experienced in Failed back surgery syndrome is often lesser than the pain the individual felt before the surgery. Although, sometimes, the pain may have an equal or even greater severity. Besides pain, some of the other symptoms observed in Failed back surgery syndrome include muscle spasms and scar tissue build up around the area of the surgery. Failed back surgery syndrome is a condition that’s complex to address and treat because of the numerous factors associated with it.
The name Failed back surgery syndrome refers specifically to pain after the procedure and does not necessarily mean that the problem was directly caused by the surgery. The condition is often treated by several pain-relieving measures, including nerve blocks, injections, and pain killers. In addition to pain management, exercises are often prescribed for strengthening the muscles around the back and try to recover functionality and range of motion.
A syndrome is a group of symptoms that are often seen and diagnosed as part of the same condition. Symptoms are grouped into a single condition called a syndrome when they are found to occur together in almost all the cases observed. For example, parkinsonism is a syndrome in which symptoms like bradykinesia, rigidity, and postural instability are all present.
The “syndrome” in Failed back surgery syndrome refers to the occurrence of back pain following back surgery. These two are grouped together, and the absence of one would not lead to the diagnosis of the condition. For example, back pain that does not follow back surgery may be a manifestation of other conditions like spinal arthritis and disc hernias.
Since Failed back surgery syndrome is a direct consequence of back surgeries, it is often managed with consideration of the back conditions the surgery was supposed to address. Some surgeries that trigger Failed back surgery syndrome include
LAMINECTOMIES
When Failed back surgery syndrome occurs after a laminectomy, it is called post-laminectomy syndrome. Post laminectomy syndrome is, in turn, often called Failed back surgery syndrome. However, Failed back surgery syndrome refers to a more general condition that follows back surgery, and not just post-laminectomy syndrome. A laminectomy is a procedure that involves removal of a lamina of the vertebrae. It is often done to reduce pressure on spinal nerves.
DISCECTOMIES
A discectomy is a condition in which one (and rarely, more than one) intervertebral disc is removed. In some cases, the adjacent vertebrae are fused together. When a discectomy is done to remove a herniated disc causing pain in the leg, the odds of Failed back surgery syndrome are very low. However, when the procedure is done for a herniation causing pain in the lower back, the surgery is not as likely to be successful.
LUMBER DECOMPRESSIONS
As mentioned earlier, a laminectomy can often be done to decompress spinal nerves. Another step is a minor discectomy. Nerve compression can often lead to conditions like radiculopathy and myelopathy.
Research shows that more than 50% of all spinal surgeries are successful. This means that they often address the conditions that warranted the surgery, and have no complications. However, the success rate of repeat surgeries decreased with every procedure.
After a second, third and fourth procedure, the success rates drop to 30%, 15%, and 5% respectively. This means that the tendency to develop Failed back surgery syndrome increases as more back surgeries are done. Another research shows that the rate of failure of lumbar spine surgery is estimated to be between 10% to 46%.
Unsurprisingly, the major risk factor of developing Failed back surgery syndrome is spinal surgery. Other risk factors may include
The diagnosis of failed back surgery syndrome involves a combination of approaches including history, physical examination and investigations. The history is taken to identify past conditions, the severity of pain felt as well as red flags like bladder and bowel disturbances or other symptoms that might have been missed in the past.
The physical examination is focused on ruling out other conditions, as well as reestablishing past diagnoses.
The investigations adopted depends heavily on the suspicions. In cases where vertebral misalignments are being investigated, plain radiographs can be of great benefit. CT scans are used when the individual has contraindications like metal implants, and an MRI scan is unsuitable. However, in most cases, MRIs are often used when diagnosing Failed back surgery syndrome.
As mentioned earlier, Failed back surgery syndrome is a complicated condition. Because of this, its treatment revolves around managing the pain and improving functional use of the back and other affected areas. Surgery becomes less of an option; the more often it has been performed. Since the success rate of the procedure reduces with each surgery, other treatment options are often explored instead.
OPIOIDS
The most significant treatment of Failed back surgery syndrome is pain modulation. This can be achieved through several means. The conservative route is often taken for individuals who do not require immediate surgery. Anticonvulsants have gained increasing popularity in managing pain of neuropathic origin. They are, therefore, the drugs of choice in managing this condition.
The use of opioids, however, is only recommended for short term use because of their tendency to cause side effects like addiction, dependence, and overdose.
PHYSICAL THERAPY
Intensive physical therapy is often prescribed for individuals with Failed back surgery syndrome. Exercises that focus on strengthening the muscles of the back are recommended. These involve movements called resisted active range of motion exercises. They help to increase the tone in the back.
Stretching exercises can also be useful. They are aimed at maintaining the range of motion in the back. Because of the pain, the individual may avoid certain movements in the back. Unfortunately, these can also lead to other conditions. Stretching exercises are thus done to combat this tendency and give the individual a more functional use of the back.
REPEAT SURGERIES
Even though the success rate of these decrease with each operation, they may be the best option available. It’s also noteworthy that repeat surgeries are very rarely necessary, and are only indicated in a handful of cases. These usually include progressive and disabling deficits of nerve origin. Examples include bowel and bladder dysfunctions and spinal instability.
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