Although generally referred to as failed back surgery syndrome or failed back syndrome, FBSS is best understood as any series of post-surgery complications, specifically in the case of spinal surgery. While post-surgery complications can occur after any surgery, failed back surgery syndrome has developed a reputation as a set of symptoms that, albeit rarely, occur in certain cases when a surgery either doesn’t take, or if complications arise in the post-surgery healing process.
Despite the dangerous connotations of a “failed back”, FBSS is treatable. The key lies in diagnosing and recognizing it early enough to address any symptoms and treat the syndrome before it worsens.
What Is Failed Back Surgery Syndrome (FBSS)?
Failed back surgery syndrome is a collection of symptoms specifically relating to back surgeries, or spine surgeries, that did not entirely accomplish what they set out to do. Rather than referring to any specific disease or illness, a syndrome is always used to describe a set of symptoms – in this case, FBSS occurs after a spine surgery gives way to a number of symptoms that suggest that, despite the procedure, there are still a few issues left to address in the patient’s back.
In other cases, it could be that the surgery itself led to new symptoms, or that post-surgery complications caused the spine to heal incorrectly, leading to pain and other sensations.
Yes, surgery can be dangerous. And yes, recovering from surgery is not pleasant either. It is normal to experience certain things, like cramps, swelling, bleeding, or pain, right after a surgery. While the body is still recovering and healing, it is tender and does not appreciate a lot of movement, and certainly no sudden jerking motions. Time, patience, and painkillers are common tools needed to get out of the post-surgery haze and move onwards to physical recovery.
Spine surgeries are quite complicated, and even with all possible measures taken, there is up to a 5% chance that a spine surgery does not lead to a successful result. However, it’s important to take that number with a grain of salt – there are many different forms of back surgery, and many different causes for back pain. Some procedures are far more complex than others, and the more complex a procedure is, the more likely something may go wrong.
In other cases, it’s possible to alleviate but not eliminate the pain and its underlying cause. By understanding what to expect after surgery and learning to differentiate that from unusual pains and signs, you can help professionals more quickly discover and diagnose FBSS if and when it occurs.
Post-Surgery Pain
Post-surgery pain is, to a certain degree, inevitable. However, past a certain point, the pain from surgery should begin to regress while the effects of the surgery – reducing pain – should take hold.
If you continue to have the same level of pain or struggle with even more pain, despite weeks of recovery, it’s likely that something went wrong either during or after the procedure. It is important to stay in touch with a pain management professional and with your doctor, and to schedule regular checkups, including imaging if you’re left with a significant amount of pain after surgery.
Nerve Pain
All pain is “nerve pain”, but certain forms of pain specifically point towards pinched nerves, recurring disc herniation, failed spinal fusion, or the formation of scar tissue around the surgical site putting pressure on a specific nerve or nerve root – all of which are possible symptoms of a failed back surgery. Each major nerve exhibits different symptoms, but common issues include severe leg pain running down the side of the leg, lower back pain getting worse, etc.
Spasms & Joint Lockage
Another bad sign pointing towards failure or the possibility of another issue is joint lockage, and muscle spasms. Muscle spasms and cramps are not too uncommon immediately after surgery, but they shouldn’t occur after recovery. If you struggle to bend your leg, or get sudden spasms and cramps preventing you from walking, then you must immediately consult a professional.
Severe Weakness
Nerves are responsible for sending signals into the body from the brain, and lumbar disc herniation often leaves people with limb paresis (partial paralysis or immobility in the limbs). Surgery to correct disc herniation quite often relieves patients of these symptoms and gives them back more control over their limbs. While it isn’t guaranteed that any given patient makes a full recovery, continued muscle weakness – or increased muscle weakness, and partial paralysis – may be a sign of FBSS.
Chronic Pain
Finally, chronic pain relief is often one of the reasons why patients seek surgery in the first place. If a procedure fails to address chronic pain, or causes a new form of chronic pain, it may be a sign of FBSS.
Treating FBSS
There are several options for treating FBSS. While common sense might dictate it’d be a good idea to try again, research shows that reoperation is actually not the best course of treatment. Unless the surgery had to somehow be cut short and must continue through reoperation, going back in to perform the same procedure on a failed back surgery syndrome often does not prove as effective as utilizing different or even less invasive treatment methods, usually involving physical therapy, active exercise, and certain select interventional procedures (different surgeries) including adhesiolysis (dividing abnormal adhesions in the spine formed after the previous surgery), nerve blocks, facet rhizotomy, and more.
Medication is also not necessarily seen as a very reliable form of treatment in the long-term but can be effective for short-term pain management. In select cases where no other treatment course brings any form of relief, a potential option for pain relief would be the installation of an intrathecal pump, designed to administer a very small dose of narcotics directly into the fluid between the spinal cord and the spinal sheath, severely reducing and often effectively managing pain in patients with severe chronic pain issues and no clear treatable cause.
Ultimately, however, treatment depends on the exact nature of what is causing the failed back surgery syndrome. While the symptoms may have first shown up after surgery, any number of issues and complications may lead to pain and chronic pain in the back and spine after a major operation. The most common cause is aberrant fusion of the vertebrae, or failed vertebrae fusion, as well as recurring disc herniation due to inadequate decompression of the spine, pain through scar tissue, and lack of postoperative rehabilitation.
Other reasons nerve or back pain may reoccur include that the original surgery did not address the main cause of the pain, or that the risk of a back surgery failing was simply higher than usual due to the factors involved in the procedure.
Common Questions About Failed Back Surgery Syndrome
Failed back surgery syndrome (also called FBSS, or failed back syndrome) is a misnomer, as it is not actually a syndrome – it is a very generalized term that is often used to describe the condition of patients who have not had a successful result with back surgery or spine surgery and have experienced continued pain after surgery.
Spine surgery is able to accomplish only two things: decompress a nerve root that is pinched, or stabilize a painful joint. Unfortunately, back surgery or spine surgery cannot literally cut out a patient’s pain. It is only able to change anatomy, and an anatomical lesion (injury) that is a probable cause of back pain must be identified prior to rather than after back surgery or spine surgery. By far, the number one reason back surgeries are not effective and some patients experience continued pain after surgery is because the lesion that was operated on is not in fact the cause of the patient’s pain.
Some types of back surgery are far more predictable in terms of alleviating a patient’s symptoms than others. For instance, a discectomy (or microdiscectomy) for a lumbar disc herniation that is causing leg pain is a very predictable operation. However, a discectomy for a lumbar disc herniation that is causing lower back pain is far less likely to be successful. A spine fusion for spinal instability (e.g. spondylolisthesis) is a relatively predictable operation. However, a fusion surgery for multi-level lumbar degenerative disc disease is far less likely to be successful in reducing a patient’s pain after surgery. Therefore, the best way to avoid a spine surgery that leads to an unsuccessful result is to stick to operations that have a high degree of success and to make sure that an anatomic lesion that is amenable to surgical correction is identified preoperatively.
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