Failed Back Surgery Syndrome

Failed Back Surgery Syndrome (FBSS or failed back syndrome) is not actually a syndrome, rather it is the condition of a patient whose back surgery has not been successful and who continues to experience pain after surgery. In some cases, the pain may become even worse after surgery.

It is estimated that the rate of occurrence of FBSS is between 5 and 50%. The high percentage of FBSS cases is attributed in part to the increased number of surgeries performed.

Causes:

There can be many reasons that surgery on the back may not be successful. Successful back surgery is only 95% predictable, so there is always the chance that surgery may not be beneficial. In many cases, the causes of FBSS may overlap. FBSS may be due to many different factors which could include:

• Surgery not being performed at the site that caused the pain
• Inadequate or inappropriate diagnosis of the source of the back pain before surgery
• Surgical complications such as infection, trauma, or bleeding
• Surgery was unnecessary in the first place
• Normal neurological functioning is interrupted by scar tissue that has formed around the site
• Technicalities of surgery are unsuccessful including:
  • Surgeon performing procedure had poor technique
  • Iatrogenic injury (an injury caused by a medical procedure) is present
• The patient was a poor candidate to have the surgery be a success

Symptoms:

•  Pain: Pain is the most common symptom of FBSS. It varies for each individual and can range anywhere from a dull ache to shooting pain. The pain may be isolated in the back (around the surgical site), or it may spread out into other parts of the body, especially into either one or both legs.
• Prickling: A prickling or tingling sensation is another common symptom that people with FBSS may have. This is usually felt most often in the feet, legs, hands, or arms. It can be constant in nature, or it may come and go.
• Numbness: A numbness or lack of sensation may also be a symptom of FBSS. This symptom will often be present if the patient also has a prickling or tingling sensation.
• Mobility: If a patient is affected by FBSS, they may also find that their mobility is affected by being worse than it was before the surgery. When this happens, the patient may have a limited range of motion in their back which may affect their ability to twist or bend their lower back. There is also the possibility of having a weakness in the legs or arms.

Treatment:

Treatment for FBSS depends on the cause. It is usually a multidisciplinary approach and may include:

•  Physical therapy
• Medications
• Nerve blocks
• Epidural steroid injections
• Exercise and stretching
• Transcutaneous electrical nerve stimulation (TENS)
• Behavioral medicine
• Spinal cord stimulation