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FAQs on Failed Back Surgery Syndrome

What is Failed Back Surgery?

When you have surgery performed on your back or neck, you expect to be pain free within a reasonable amount of time. Unfortunately, this is not always the case. . Since this is such a common occurrence, researchers have actually named the set of symptoms following surgery as “failed back surgery syndrome”. It can be frustrating for both the patient and the doctor to find that even the most aggressive treatments didn’t solve the problem of back discomfort.

Some cases are more prone to failed back surgery than others. Back pain that doesn’t have a verifiable cause, such as radiographic evidence of a herniated disc, is less likely to benefit from surgical intervention on the back. In some cases, the surgeries themselves fail due to grafts failing to fuse the bones together, and this can happen for a number of reasons.

Because failed back surgery syndrome is so common, many surgeons insist upon long term attempts to heal back pain with non-surgical or minimally invasive measures. Truly, back surgery, especially spinal fusion, should be used only in the most treatment resistant cases because this phenomenon can crop up at any time.

Back surgery fails for several reasons. One possibility is that the problem corrected by the surgery might not actually have caused the pain. This is often the case when a herniated disc is suspected, but the signs are not clear cut. By removing the disc and fusing the bones, the actual cause of the pain was not addressed, and the pain continues. Failure of fusion is another problem, and this can be caused by smoking, failure to follow up with physical therapy, and simple failure of the bone graft system.

Other causes are not as obvious. Sometimes, the nerve damage is bad enough that even removing an impinging disc doesn’t stop the pain. The nerve will continue to send pain signals despite the removal of the mechanical problem. In addition, back surgery itself can cause nerve damage. Simply manipulating the tissues of the back or neck can lead to nerve pain that either makes the initial pain worse or causes pain that didn’t exist prior to the surgery. . Finally, some back surgeries simply fail, and no one is quite sure why.

Failed back surgery can feel like the pain you had before or the pain can be entirely different. In cases of nerve damage, the pain may be depressingly the same. You may have aching, shooting pains in your limbs, and the surgery may not have helped to change those sensations at all. Much more common, however, is the pain is reduced to some extent, but it does not completely resolve. Most patients expect, though, that if they have surgery they will be pain free, and this is often not the case with back surgery. The pain may also be different than what you experienced prior to surgery. If some of the nerves are damaged during the process of the fusion, you may feel pain in different parts of your body. In addition, if the fusion does not take, you may start to experience a different pain from the non fused bones moving. Sometimes, even if nothing went amiss with the fusion, you may still experience new pain from spinal fusion surgery. This is because the physics of the back change with fusion, and you may find that other levels of your spine are impacted and uncomfortable. We frequently see breakdown of the spine above and below the level of the fusion.
Failed back surgery is first treated conservatively. Various medications are the initial line of treatment. There are a whole host of medications in different classes that may prove beneficial. These may include NSAIDS, pain medications, topical pain creams and adjuvant analgesics. Narcotics are only used in extreme circumstances, and even then they are used sparingly. Injections into the disc or the area of inflammation may be helpful. A combination of medication, physical therapy, and injections is usually enough to combat failed back surgery syndrome. Occasionally, a spinal cord stimulator is required. It is unlikely that another surgery would be helpful or even recommended in the case of a previous failed surgery.