Failed Back Surgery

WHAT IS FAILED BACK SURGERY?

Also called Failed back surgery syndrome, this term describes new or persistent pain that occurs after spinal surgery for the treatment of leg or back pain. It is the most irritating and frustrating experience at the same time. Patients feel like they are better right after the surgery, but then the problem worsens. It doesn’t mean that the surgery goes wrong or the surgeon didn’t perform well, but it occurs due to different reasons.

WHAT IS THE CAUSE OF FAILED BACK SURGERY?

The main reason that is considered to be the common cause of failed back surgery is pseudoarthrosis, where the spinal fusion fails. In spinal fusion surgery, the spine is just stabilized, it gets fused after some time, but in some patients, the fusion doesn’t occur and the screw/rods used in the stabilization of the spine loosen with time and the person suffers from the worst back or leg pain.
Another reason is the damage to the level of the spine next to the previously damaged level. The spine has a different level it might be possible that a patient is having a successful surgery at a level, but there is a problem on any other level of the spine this may also lead to failed back surgery despite a successful surgery otherwise.

WHAT ARE THE SYMPTOMS OF FAILED BACK SURGERY?

Chronic pain is the most common symptom it can be dull sharp, occur in the back, neck, or legs. Neurological symptoms also appear, including weakness, tingling sensation. Pain spread from one area to another area of the body—limited motion in your neck and lower back. Headache occurs after a neck (cervical) procedure indicating a problem in the nerve. Severe symptoms include difficulty in walking, the lower body having electric-like pain, fever, vomiting, weight loss, loss of bowel, or bladder function.

HOW CAN FAILED BACK SURGERY DIAGNOSED?

Diagnosis is essential even if someone feels pain after 5-10 years of surgery; the underlying causes should be identified. The surgeon will ask some questions and also performs some test for better diagnosis. The hospital should have all the proper diagnostic equipment.

  • The surgeon will ask for your medical history.
  • He or she will determine your psychological health as people suffering from anxiety, depression, or any other psychological disorder have enhanced awareness of pain.
  • Next, the surgeon is going to perform a specific physical test; he will touch and feel certain parts of the spine to identify any tenderness or spasm. Your doctor will also ask you to perform different physical activities, e.g. twisting, walking, etc.
  • He will also do neurological examinations and will review current symptoms.
  • He will further confirm the diagnosis with the help of imaging scans like X-rays, CT scans, bone scans, etc.

WHAT IS THE TREATMENT FOR FAILED BACK SURGERY?

After the diagnosis, the doctor will plan a treatment to address the pain and symptoms. Usually, the treatment starts with physical therapy or any exercise. Then the surgeon may prescribe medication like NSAIDs, acetaminophen, cyclooxygenase 2 inhibitors, tramadol, etc. He/she may suggest interventional procedures like caudal ESI; percutaneous adhesiolysis etc. Neuromodulators, including SCS and others, are the best long-term management used to treat pain in FBSS patients. If untreated by the above procedures, then the surgeon will opt for surgical procedures and might undergo reoperation.