Failed Back Surgery Syndrome (Post-Laminectomy Pain Syndrome)

Back and neck pain is unfortunately very common. More than 80% of adults have suffered from back pain at some point in their lives. It can have many causes including athletic, traumatic injury, or age-related degeneration. Some pain may be temporary and resolve on its own, but some types of back pain require medical intervention to manage. For some, surgery may be one of the only treatment options. However, surgery doesn’t always bring pain relief. Up to 40% of patients have experienced continued pain after surgery, which is often referred to as Failed Back Surgery Syndrome (FBSS).

What is Failed Back Surgery Syndrome? Is it really a “failed” procedure?

Failed back surgery syndrome (or failed back syndrome) is a misnomer, as it is not meant to imply there was necessarily a problem during surgery. It is a very generalized term that is often used to describe the condition of patients who have not had a successful result with back surgery or spine surgery and experienced continued pain after surgery.

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In some cases, the pain was reduced but is still present, or it may have gotten worse. Patients may have felt relief for a little while, but then the pain started again. Their symptoms might have gone from back pain to leg pain or from leg pain to back pain, or both. In addition to chronic back pain, other symptoms of failed back surgery may include neurological symptoms (eg, numbness, weakness, tingling sensations), leg pain, and radicular pain (pain that spreads from one area of the body to another, such as from your neck down to your arm).

What causes FBSS?

There are many reasons that a back surgery may or may not work, and even with the best surgeon and for the best indications, spine surgery is not successful for many patients. Back surgery or spine surgery cannot literally cut out a patient’s pain. It is only able to treat the injury or probable cause of back pain, which must be identified before back surgery or spine surgery is performed. The likelihood of developing FBSS is considered greater with repeated surgery, and the condition will be more prevalent in regions where spinal surgery is more common.

Risk Factors That Increase Your Chances of Failed Back Surgery Syndrome

Several factors may influence whether you have failed back surgery syndrome after your spine surgery, and they may occur before your surgery (pre-operative), or pain after back surgery (post-operative).

Pre-Operative FBSS Risk Factors

The risk factors below will not necessarily prevent a patient from undergoing spine surgery; however, adequately addressing these issues before surgery will increase the chance of success.

Pre-operative FBSS risk factors include:

  • Presence of mental and emotional disorders (eg, depression, anxiety)
  • Surgery is tied to a workers’ compensation case or other legal issue
  • Obesity
  • Smoking (eg, tobacco use)
  • Patients with chronic pain related to other conditions such as fibromyalgia

Intraoperative FBSS Risk Factors include:

  • Inadequate decompression: Failing to create enough space around spinal nerves/spinal cord
  • Excessive decompression: Creating too much space around nerves, which may lead to spinal instability
  • Surgery performed at the wrong level (incorrect surgery)

Post-operative FBSS risk factors include:

  • Recurrent original diagnosis (eg, recurrent disc herniation at the same site or at a nearby level)
  • Adjacent segment disease (ASD) after spinal fusion where the level above or below a fusion has increased stress and therefore can degenerate in an accelerated fashion
  • Epidural fibrosis (when nerve roots are trapped by scar tissue)
  • Spinal infection
  • Spinal balance-related issues (sagittal imbalance), which can accelerate degeneration
  • Spinal nerve root irritation, which can cause radiating pain after back surgery
  • Pseudoarthrosis, lack of bony fusion despite hardware being placed

How is FBSS Treated?

Like preoperative back pain, symptoms can resolve themselves in a matter of weeks or months, so conservative treatment is usually the recommended initial therapy for FBSS. Conservative treatment can include:
  • Rest
  • Activity modification
  • Nonsteroidal anti-inflammatory medications (NSAIDs)
  • Corticosteroid injections
  • Physical therapy
However, if conservative treatments do not help, patients may need to consider other non-surgical or minimally invasive treatments such as:
  • Nerve blocks
  • Transcutaneous electrical nerve stimulation (TENS)
  • Membrane stabilizers (oral non-narcotic medication)
  • Spinal cord stimulation

If you and looking for back pain doctors in San Antonio, we can help. At The PainSmith, we provide customized and compassionate pain management care. We offer a variety of diagnostic procedures designed to pinpoint the source of your back pain. During a one-on-one consultation, your doctor will evaluate your symptoms, lifestyle and medical history to identify the problem and develop an effective treatment plan that best meets your needs and goals.

For more information on back pain treatment in San Antonio, give us a call today at (210) 963-7493. If you would like to request an appointment online, you can do so through our convenient online appointment request form.

*The PainSmith team has reviewed this information. It is intended for informational purposes only, not to replace the advice of your doctor or other health care provider. Please discuss any questions or concerns you may have with your provider.

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