Understanding Failed Back Syndrome: The Work Begins a New (Ted Kennedy Voice)

Living with chronic back pain can be a frustrating experience, and for some individuals, it becomes a prolonged battle even after undergoing various treatments. Failed Back Syndrome (FBS) is a term used to describe the persistence or recurrence of chronic pain following back surgery. Here, we will explore the ins and outs of Failed Back Syndrome, exploring its causes and available management options.

What is Failed Back Syndrome?

Failed Back Syndrome, also known as Failed Back Surgery Syndrome (FBSS), is a situation more than a syndrome or a condition. It occurs when a patient continues to experience pain after undergoing spinal surgery. Despite the best efforts of the surgeon, the desired relief is not achieved, and the patient's pain persists, returns, or worsens. In short, sometimes surgery may not have the desired outcome, and patients may even feel worse. Thankfully, this situation is relatively uncommon.

Causes and Risk Factors:

Several factors can contribute to the development of Failed Back Syndrome, including:

Technically challenging surgery.

Spine surgeons by nature are detail-oriented and analytic. Even so, when the technical demands and complexity of surgery or high, it is possible for the technical goals of surgery not to be met.

Elusive diagnosis.

Spine surgeons treat patients based on a working diagnosis, or leading diagnosis. We keep a list of potential alternate diagnoses, also known as differential diagnoses. We try our best to gather evidence and run tests (imaging, injections, exam maneuvers, and/or emg/nerve conduction studies) to identify the right diagnosis. Unfortunately, and thankfully rarely, the working diagnosis is the source of error.

Other ongoing, pre-existing spinal issues.

One major key for success in surgery is that we must set the expectations for surery well. Some patients have multiple spine problems that occur in tandem. They may believe that all of their symptoms are attributable to only one structural problem as opposed to there being more than one structural problem. If a patient has an expectation that there is only one problem when there is more than one problem, the patient won’t be happy when they have residual symptoms after one surgery.

Psychological factors

Mental health, stress, anxiety, and depression can influence the perception of pain and contribute to the persistence of symptoms. Sometimes these factors may even be the main source of pain.

Diagnosis and Treatment

The simplest approach is usually the best approach. The first step in working up the situation of failed back surgery is to ask why the index surgery was performed. I then ask if the working diagnosis for surgery was correct, if the strategy for surgery was correct, and whether the goals of surgery were met. Usually the goals of spine surgery involve decompressing nerves, realgning the spine, and/or stabilizating the spine. Once we have a working diagnosis, the work begins anew, and we climb the orthopedic treatment ladder like always. Repeat surgery is elective unless there’s an urgent consideration. The success rate for reoperation is not high and so considering surgery again has to be done with a lot of thought and care.

While Failed Back Syndrome may present significant challenges, it's essential to remember that you are not alone in your journey. Staying positive and being patient with the healing process can make a significant difference. Embracing a comprehensive approach to coping with pain can empower you to lead a fulfilling life, even in the face of Failed Back Syndrome. As with all stumbling blocks in life, regain your footing and keep moving forward.

I hope you have found this information helpful!

Best regards,

Dr. B

Orthopedic Surgeon

Bristol Health

Disclaimer: No content on this site should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.