What is failed back surgery syndrome (FBSS)?

Whilst this is called failed back surgery syndrome (FBSS), it is not actually a syndrome, but is a term used to describe patients who have had unsuccessful results from their back or spinal surgery. Following their failed surgery, they are often left with continued back pain. Back surgery is fairly complex, and equally so is the process of identifying the specific source or sources of a patient’s back pain. Hence, failed back surgery often arises because sources of back pain themselves are difficult to diagnose.

Prognosis:

Whilst failed back surgery does cause continued pain, recent improvements in imaging technologies that can be used operatively are allowing for more effective surgeries. For example, continuous X-ray, known as fluoroscope, and CT computer-assisted navigation technologies are helping to both prevent failed back surgery, and to help in correcting it.

Symptoms of failed back surgery syndrome:

The hallmark symptom of failed back surgery is continued chronic back or neck pain. To summarise, symptoms of failed back surgery can include:

• Back pain that may be achy or dull
• Leg or arm pain
• Numbness with a sensation of tingling
• Pain that is sharp or stabbing in the back, arms or legs

Medical tests to diagnose failed back surgery syndrome:

If your back surgery has failed and you continue to have symptoms of pain, your specialist should run the following tests to confirm:

• Physical examination
• Medical history
• Imaging tests (e.g. X-rays, CT scan, MRI scan)

What are the causes of failed back surgery syndrome?

There are numerous reasons why back surgery can fail or be unsuccessful in treating the original problem. Even the best surgeons, or a team of surgeons, may not achieve successful results with back surgery. The main reason for this is that back surgery treats back pain and pain cannot simply be removed or cut out.

Back surgery will usually aim to either:

• Decompress a nerve or nerve root that has been pinched; or
• Provide stability to a painful joint

Hence, if the initial back surgery does not target the correct source of the patient’s back pain, then it will not be successful in eliminating their pain. Failed back surgery may also result from the formation of scar tissue, such as epidural fibrosis, that sometimes forms near nerve roots, causing post-operative pain.

Can failed back surgery syndrome be prevented?

There are a few ways that failed back surgery can be avoided. Firstly, before surgery is undertaken, every effort should be made to correctly identify the exact causes of their back pain. This means that only areas in the back actually contributing to pain will be operated on. Secondly, certain forms of back surgery have a better success rate than others. For example, a discectomy has better outcomes for treating lower back pain caused by a lumbar herniated disc than if it is causing leg pain. Additionally, spinal fusion surgery is fairly reliable for treating spinal instability, but not for certain forms of degenerative disc disease.

Hence, the best way to prevent failed back surgery syndrome is to use the procedures that have good levels of success for specific causes of back pain.

Treatments for failed back surgery syndrome:

Failed back surgery may be treated in a number of ways: 

• If it is treated with conservative methods, these may include steroid injections to provide pain relief, or nerve root blocks.
• Decompression surgery is also another option. This will relieve pressure on the spinal nerves, relieving pain too. Decompression works by removing soft tissue (e.g. scar tissue) or bone spurs to allow decompression on a nerve.
• Lastly, spinal fusion surgery may be used to provide stability for the spine. This may involve the use of artificial discs to replace damaged ones.

Which type of specialist treats failed back surgery syndrome?

An orthopaedic surgeon who specialises in back surgery would treat failed back surgery syndrome, or a neurosurgeon who specialises in spinal surgery.