Lower back pain disproportionately affects an estimated 65 million Americans, making it the most common type of pain reported in the US, and the most common form of chronic pain. The lower back is also far more susceptible to injuries than any other point of the spine, including the neck and upper back, and 2019 saw Americans receiving roughly 1.62 million instrumented spinal procedures.
However, while spine surgery is only recommended when all other options have been exhausted, it’s not a guaranteed fix either. About half of all first-time spine surgeries are successful, but a little less than half are not. There are people who do not experience the relief they need through surgery.
There are alternative treatment paths to get to the root of the issue. Including a second, or revision surgery, meant to address new symptoms or better target the root cause.
What Is Failed Back Syndrome?
Failed back syndrome, or failed back syndrome (also known as post-laminectomy syndrome) is a collection of symptoms experienced after a spinal surgery, typically somehow indicating that the surgery was not as successful as expected.
The term itself is somewhat of an anomaly. All surgeries have a chance of failing to address the pain they’re trying to resolve. However, one reason why failed back surgeries uniquely reserve a separate term is because of how common they are.
Don’t let the term scare you into thinking that nothing else will work. Or into believing that this is a problem that is unique for back surgeries. Surgery is inherently risky and may not always address the full scope of the problem.
Types of Spine Surgery
Most cases of spine surgery aim to correct problems in and around the spine. This can be by fixing and removing deformities, cutting down bone spurs, decompressing nerves, and stabilizing the spine. Common forms of spine surgery include:
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- Discectomy (removing a portion of an intervertebral disc, the spongy bit between the vertebrae)
- Foraminotomy (enlarging the bony passageway that nerve roots use to branch off the spinal cord into the body)
- Laminectomy (bone removal, to relieve pressure on nearby nerves)
When stabilizing the spine, instrumentation is used to ensure that the spine heals properly by keeping it aligned and giving the bone every opportunity to fuse back together properly. Instrumentation, or spinal “hardware”, consists of screws, plates, hooks, cages, bolts, and various other surgical implants designed to create an internal cast around the vertebrae to keep them in a rigid position that helps them heal.
Symptoms of Failed Back Syndrome
The most basic example of failed back syndrome is significant pain felt after the initial post-op recovery phase (where pain is normal). If the operation did nothing to improve your original symptoms, it has failed. Somehow made the pain worse, it has failed. If it replaces one pain with another that is equally bad, or worse, it has failed.
Some symptoms of failed back syndrome are far more severe than others. It requires immediate medical attention and, in some cases, immediate revision surgery. These are symptoms that necessitate a visit to the emergency room. Or go to your own doctor as soon as possible.
These include signs of significant nerve damage (numbness, severe loss of strength, loss of bowel control), or any signs of spinal infection. As well as signs of broken or unstable spinal instrumentation during follow-up screening and testing.
When the signs of failed back syndrome are milder and don’t suggest any immediate danger to the spinal cord or pseudarthrosis (failed spinal fusion), there are a number of different treatment options based on the patient’s complaints and circumstances.
Is Revision Surgery Always Necessary?
It is not. While the first surgery is a last resort already, signs that it did not work can mean taking things back to the drawing board to determine a better way. Sometimes, new symptoms that arise after surgery can be addressed through non-surgical treatment.
Some treatment options that you can explore include:
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- Non-opioid painkillers
- Off-label painkillers like ketamine and antidepressants
- Non-surgical interventions such as corticosteroid injections
- Radiofrequency ablation
- Antibiotic treatment
- And more
Another reason why revision surgery can be with some reluctance is because there’s a lower chance of success in each subsequent spine surgery. While the first surgery ends up relieving the issue more than half of the time, the chance of success for surgery number two is 30 percent. Third and fourth surgeries are less successful, at 15 and 5 percent respectively.
A Second Surgery
If non-surgical treatment options show no signs of working, your specialist may recommend revision surgery. This is to ensure that you’re mentally and physically ready to undergo the surgery. They will ask you to fulfill a series of tests including a psychiatric evaluation. This is just to ensure that you’re completely aware of the risks, and agree to a second surgery while wholly conscious of the circumstances.
There are, as previously mentioned, cases where a second surgery is a necessity and becomes an immediate course of action. These include sudden and severe neuropathy following the first surgery, as well as broken or moved instrumentation, a post-op infection of the spine, and failed spinal fusion.
Other circumstances that may increase the relevance of a revision surgery include signs that scar tissue are presenting new nerve compression problems, the identification of a second or separate diagnosis, or other complications, such as adjacent segment disease (wherein the spinal segments nearest to those stabilized by instrumentation take on additional stress).
What Does Revision Surgery Entail?
Once more, revision surgery will require your doctor to identify how and where best to decompress the nerves of the spine and stabilize your spinal column. Different symptoms and problems will require different surgeries. This can be from debriding infected tissue or removing bone spurs, to promoting blood flow, reducing decompression, and more.
After your second surgery, follow-up is critical. Your spine specialist will order a series of tests and imaging sessions to ensure that everything is healing as it should, and that there are no more curve balls.
Always Consult Your Doctor
A revision surgery is very serious, just as the initial spine surgery was. Choosing to get a revision surgery means first exploring every alternative option and getting a full scope of the problem. It’s important that you thoroughly discuss your options with your doctor and listen closely to all potential alternatives.
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