FAQ’s on Failed Back Surgery Treatment in Philadelphia

 

Failed back surgery syndrome (FBSS) is a condition characterized by chronic back pain after spinal surgery. When surgery fails to offer relief of back pain, the term FBSS is often used.

What are the causes of FBSS?

Spinal surgery is supposed to stabilize painful back joints, relieve pain, and decompress one or more compressed nerves. Back surgery does not help every patient, however. The cause of back and leg pain associated with FBSS include:

  • Recurrent disc herniation
  • Scarring (fibrosis)
  • Fracture
  • Adjacent segment syndrome
  • Altered joint mobility and spinal instability
  • Muscle atrophy
  • Failure to remove nerve-compressing structures and material
  • Procedure fails to remove a lesion or herniation
  • Spinal fusion does not take

What are the symptoms of FBSS?

People with FBSS often report chronic, severe back pain. When nerve compression is involved, symptoms include leg weakness, numbness, tingling, and pain.

How common is failed back surgery syndrome?

According to estimates, approximately 600,000 individuals have back surgery each year, and of these people, many continue to report pain and other symptom. FBSS is said to affect between 20-40% of all surgical patients.

Who is at risk for FBSS?

Certain diseases put a person at increased risk for failed back surgery syndrome. These include multiple sclerosis, rheumatoid arthritis, peripheral vascular disease, diabetes, and lupus erythematosus. In addition, patients who do not follow pre- and post-surgical guidelines have an increased risk for pain after surgery.

What are the symptoms of FBSS?

The pain can be persistent or intermittent, achy/throbbing or sharp/shooting, and it can radiate down to the buttocks and legs. The pain may worsen after a few months post-surgery due to a buildup of scar tissue around the spinal nerve roots. Other symptoms include muscle spasms, leg weakness, and mobility issues.

How common is failed back surgery syndrome?

Many published reports estimate the incidence of FBSS to be between 20-40%, but the exact number is not known. In the U.S., there are approximately 250,000 low back surgeries performed annually.

How is FBSS diagnosed?

After surgery, when pain continues, the doctor will ask you questions about your condition and do a physical examination. In addition, the doctor will conduct several diagnostic tests to assess for scarring, spinal instability, and/or structural problems. These include x-rays, CT scans, and MRIs. If nerve problems exist, the doctor may perform a nerve conduction study.

What are the treatment options for FBSS?

The treatment of FBSS depends on the cause of the pain, the severity of the condition, as well as which treatments have worked or do not work. Options include:

  • Medications – If nerve pain is present, the doctor may prescribe medications such as Neurontin or Lyrica. In addition, non-narcotic pain medicines include ibuprofen, naproxen, and ketoprofen. For severe pain, opioid analgesics are used.
  • Physical therapy – To alleviate pain, the physical therapist uses electrical stimulation, ultrasound, massage, and heat/cold therapy. For improved strength and increased flexibility, the therapist uses exercises and stretching maneuvers.
  • Epidural steroid injection (ESI) – The epidural space lies between the spinal cord and the epidural layer that surrounds it. With ESI, the doctor injects a long-acting steroid into this space, which alleviated pain associated with inflamed nerves.
  • Facet joint injection (FJI) – This is done to alleviate pain in the small joints along the posterior region of the spine. A long-acting anesthetic, with or without a corticosteroid, is instilled into the space. A clinical study conducted recently found that FJIs were useful for long-term pain relief.
  • Spinal cord stimulation (SCS) – When the patient fails on other treatment modalities, the doctor can surgically implant a small device in the abdomen. Wires run from the device and attach onto electrodes, which are surgically positioned along the spinal cord. The device delivers pleasant electrical sensations to the spine, which interfere with pain signals. In recent clinical studies, SCS is effective for relief of pain long-term.

Resources

De Ridder D, Plazier M, Menovsky T, Kamerling N, & Vanneste S (2013). Subcutaneous stimulation for failed back surgery syndrome: A case report. Neuromodulation.

Falco, FJ, Manchikanti, L, Datta, S, et al. (2012). An update of the effectiveness of therapeutic lumbar facet joint interventions. Pain Physician, 15(6), 909-953.

Jacques L, Jensen T, Rollins J, Burton B, Hakim R, & Miller S (2012). Decision memo for transcutaneous electrical nerve stimulation for chronic low back pain (CAG-00429N). tinyurl.com/ decisionmemoTENS