Back Surgery May Not Be the Answer


For people suffering from chronic, debilitating back pain, relief can’t come fast enough.  Sometimes pain sufferers rush into surgery, thinking they can “cut away” the pain and finally experience freedom from it. Unfortunately, even though more than 600,000 Americans opt to undergo traditional open back surgery every year, it’s estimated that up to 40 percent of those patients experience failed back surgery syndrome (FBSS). Also known as post-laminectomy syndrome, FBSS is a term used to describe patients who continue to experience back pain after surgery. According to the National Institutes of Health (NIH), the likelihood of FBSS increases with the invasiveness of the spinal surgery performed.

How does FBSS happen?

While back or spine surgery can’t cut away your pain, it can alter your anatomy if an anatomical injury is the cause of the pain. Yet the number one reason patients experience FBSS is because the anatomical injury operated on is not the cause of their pain. This may be because making an accurate diagnosis is not always straight forward, particularly if a nerve root compression in the spine leads to symptoms in distant parts of the body. In addition, other sources of pain, such as osteoarthritis can produce symptoms that are very similar to degenerative spine conditions.

FBSS can also have a number of other causes, including:

  • Scar tissue formation around the nerve root
  • Inadequate decompression of a nerve root
  • Joint or nerve irritation during the procedure
  • Failure of the spine to fuse during spine fusion surgery

Common symptoms of FBSS include:

  • Dull, persistent and aching back pain in the back, neck or legs
  • Sharp or stabbing pain in the extremities
  • Limited mobility
  • Spasms
  • Inability to recuperate
  • Anxiety and depression

Diagnosing the real cause of your pain

Accurately determining the correct source of your FBSS-related pain is critical to successful treatment. Proper diagnosis begins with a thorough clinical evaluation from your pain management specialist, which should include your medical history and a physical examination. During the general physical exam, neurovascular and musculoskeletal exams should be done to rule out all possible causes of symptoms other than FBSS.  Testing might include x-rays, MRI and/or CT scans to evaluate persisting nerve compression or other disc disease, and to rule out infection or tumor. Electromyography (EMG), which is a diagnostic procedure used to assess the health of muscles and the nerve cells that control them, can also be performed.

Treatment is possible

Like most chronic pain, FBSS requires pain management and coping strategies to keep the pain under control. Pain management options include controlling inflammation and irritation of the nerve with the following treatment options:

  • Epidural steroid injections delivered to the nerve roots or facet block injections to treat inflamed facet joints.
  • Radiofrequency ablation (RFA), a procedure that uses electric current to heat up small areas of nerve tissue and prevent transmission of pain signals from that area may also prove helpful.
  • Spinal cord stimulation (SCS), a pain-relief technique that uses low-voltage electric current to interrupt how pain signals are sent to your brain. Recently, there have been new advancements to spinal cord stimulation to achieve up to 70 percent pain relief in your back and legs without the tingling sensation felt with the older device.

Complementary and alternative medicine (CAM) options like physical therapy and acupuncture may also prove helpful in treating FBSS. Before choosing surgery to address back pain issues, make sure you do your homework and speak to a pain management specialist about all of the pain-relief treatment options available to you. If you’d like to learn more about these options—or about options for addressing FBSS—call Pain Management and Injury Relief at (877) 724-6349 to make an appointment today.


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