What Is Failed Back Surgery Syndrome, and How Do I Manage It?

By December 18, 2020 January 13th, 2021 Educational Videos, Failed Back Surgery Syndrome

About 9% of the population experiences low back pain. Both localized pain and radiating pain can reduce function and comfort, leading many to promptly seek treatment. While some back pain can be treated non-surgically, problems where the body’s structure pinches a nerve often need surgical correction. With the growing cases of back pain, back surgeries are on the rise as well.

Back surgery is both time and money intensive. The hope of relief weighs heavily on you when the pain is so constant. Understandably, there’s enormous frustration and discouragement if the back surgery fails. 

Unfortunately, failed back surgery syndrome (FBSS) occurs anywhere from 20-40% of the time.1

What is failed back surgery syndrome?

Failed back syndrome is a pain in the lumbar area that persists or begins after surgical intervention.2 The title can be misleading, as it’s not a syndrome as much as it is a failed outcome. 

It can be an umbrella term—these are some common failed back surgeries:

  • Failed spinal fusion. In this case, the vertebrae that were surgically connected do not stay appropriately fused. 
  • Failed disk decompression. In this case, discs were separated to relieve pressure on a nerve. But the area has gone back to pinching the nerve. It may have also not been decompressed enough.3
  • Formation of scar tissue. The original surgery is meant to relieve pressure on nerves. Unfortunately, there’s no way to avoid scarring. If the scarring is thick enough, it can compress the nerves again.

It’s important to know that a recurrence of your pain may point to something else. It may not be from a failed back surgery. 

Some pain after back surgery is normal.4 Inflammation and the surgical site will have pain for around at least a week. Your surgeon will develop a pain management plan. 

It’s also possible that the problem that started the back pain came back. Discs can slip again, and bones and ligaments can thicken and compress the spinal cord.5

Injury can also recreate the problem. Twisting and lifting after surgery can damage the spot that’s trying to heal. Also, if your pain recurs many years after your surgery, it may be due to normal wear and tear.

If you believe your back surgery has failed or has had a complication, call your doctor or surgeon.

What are the symptoms of failed back surgery?6

  • Your chronic back pain is not relieved. The quality of the pain may be different as well, such as radiating pain instead of general pain.
  • You have numbness and tingling in your legs and or arms. This sensation should not persist after surgery.
  • You have pain that goes from your back all the way through your extremities. This pain may show up in one or both of your extremities.
  • Your pain has worsened since your surgery. Initially, you may have surgery-related pain, but it should not persist after you heal.

How can my doctor diagnose me with FBSS?7

You may feel numbness and tingling a few weeks after surgery, but this usually resolves. You may also have surgery pain related to swelling and your wound. This is normal and isn’t likely a sign of surgery failure. 

For many back surgeries, you’ll be up and walking within 24 hours. Recovery takes a few weeks to a few months, depending on how invasive your surgery was. To diagnose your pain as true failed back surgery syndrome, the doctor will need to link your symptoms to a previous surgery. They will physically assess the area, but also get a detailed history of your pain, any injuries, and your past. They may order some imaging, like an MRI or x-ray.

During normal spine surgery recovery, you may have some nerve troubles that won’t represent your new normal.8 

Why can a back surgery fail?

Here are a few reasons back surgery may not have been successful:

  • Surgery did not relieve the issue adequately. For example, if the back surgery was for spinal stenosis (where the opening the nerve passes through is too small) too little or too much space may have been created during the surgery. 
  • Surgery was done on the wrong area. Unfortunately, this is not an uncommon occurrence. One review found that 13.1% of surgeries were performed on the wrong site.9
  • Certain habits kept you from getting the full benefit of your back surgery. Problems that precipitated the back pain can harm it again if they continue after surgery. Staying seated for long periods of time and repetitive movements are common offenders.
  • The original disease and structural problems can come back again. For example, if your back surgery was for a slipped disc, you may have slipped the disc again. If the area needed to have vertebrae fused (a laminectomy), the bones may have not kept together.
  • Scar tissue caused pressure. Even though the pressure may have been relieved by the surgery, there’s no way to avoid scarring. Unfortunately, this bulky tissue can press on the nerve in a similar way the original problem did.

What is the treatment for failed back surgery syndrome?

First, you’ll need an evaluation from your doctor or surgeon. Your doctor may refer you to another back specialist. You will likely get a round of imaging for a better look at your post-surgical back. 

The treatment may or may not be another surgery. Surgery success tends to go down with subsequent surgery.  However, it will depend on what’s causing your back problems. If your disability is progressing quickly or puts you at risk for imminent irreversible damage, you may need another surgery.

Most importantly, you’ll need a multi-disciplinary approach to your plan of care. Professionals that could help you include your primary care doctor, and your surgeon, a physical therapist, and a pain management specialist.

If you’re having pain from failed back surgery, let’s discuss your case.

No matter the cause, a back surgery that did not have the intended outcome is devastating. Dr. Tollestrup and his team specialize in nerve problems and want you to meet your desired outcomes, whether or not you have already had surgery. You can call to discuss your case at 702-505-8781. 

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590156/ 
  2. https://journals.lww.com/clinicalpain/citation/1995/06000/classification_of_chronic_pain_descriptions_of.24.aspx 
  3. https://www.asahq.org/madeforthismoment/preparing-for-surgery/procedures/back-surgery/ 
  4. https://www.spine-health.com/treatment/back-surgery/failed-back-surgery-syndrome-fbss-what-it-and-how-avoid-pain-after-surgery
  5. https://www.nhs.uk/conditions/lumbar-decompression-surgery/risks/#:~:text=Recurrent%20symptoms%20can%20be%20caused,similar%20symptoms%20to%20nerve%20compression 
  6. https://www.spineuniverse.com/conditions/failed-back-surgery#:~:text=In%20addition%20to%20chronic%20back,neck%20down%20to%20your%20arm).
  7. https://nyulangone.org/conditions/failed-back-surgery-syndrome-in-adults/diagnosis
  8. https://medlineplus.gov/ency/patientinstructions/000313.htm  
  9. https://www.jointcommission.org/-/media/deprecated-unorganized/imported-assets/tjc/system-folders/topics-library/old-se-stats/2004-2015_se_stats_summarypdf.pdf?db=web&hash=D0881659987214DA6FBD699A2B4B98FA
[This article is not meant to diagnose or provide medical advice. If you have health concerns, speak with a medical professional.]