Failed back surgery syndrome (FBSS) is the name given to a condition characterized by chronic pain following spinal surgery. FBSS is not a syndrome as such, but rather a general term to describe a failure of the spinal surgery to provide long-term relief from back and leg pain. No equivalent phrase exists for those who have had an unsuccessful cardiac surgery or brain surgery, perhaps because back surgery is the most common type of surgery conducted in many countries, including the US. The causes of failed back surgery syndrome are various and may overlap in many cases. Whilst the condition’s name usually refers to the persistent pain that patients experience after back surgery which corresponds to their pain prior to surgery, it can also be used to identify pain which develops after back surgery that was not previously present.
Causes of FBSS
Causes of back and leg pain associated with failed back surgery syndrome include, but are not limited to:
- recurrent disc herniation
- altered joint mobility including hypermobility and instability of the spine
- scarring (epidural fibrosis)
- adjacent segment syndrome
- failure to remove all nerve-compressing material
- muscular atrophy (deconditioning)
Failed back surgery syndrome patients may also suffer from depression, anxiety,sleeplessness, and even post-traumatic stress disorder if surgery was particularly stressful. Back surgery aims to either stabilize the spine, remove material causing nerve root compression, or achieve both; it is not guaranteed to remove patients’ pain completely, or at all, and the number one reason for failed back surgery syndrome is that the lesion or anatomical variation operated on is not the actual cause of a patient’s back or leg pain.
A predisposition to develop failed back surgery syndrome may exist in patients with other health conditions such as diabetes, peripheral vascular disease (circulatory problems), or autoimmune conditions such as rheumatoid arthritis, multiple sclerosis, or lupus erythematosus. Patients who fail to follow pre- and post-surgical guidelines increase their risk of failed back surgery syndrome, particularly those who continue to smoke, and patients who try to rush their recovery by returning to work and vigorous exercise too quickly. Similarly, patients who are unfortunate enough to suffer further back trauma, from a car accident or fall for example, may also develop complications and failed back surgery syndrome.
Symptoms of FBSS
Symptoms of the condition not only include sharp pain but can be experienced as a dull and persistent ache in the back or legs, abnormal sensations such as prickling or tingling in the legs and extremities, and numbness, weakness, or burning pains. In some cases the development of a tingling and warm sensation in the extremities can indicate the recovery of a nerve damaged and compressed prior to surgery. As the nerve heals the sensory function is restored and may contribute to the pain and altered sensation immediately after surgery. In these cases the pain will usually subside and a degree of normal nerve function will be restored over time.
Patients who experience no relief of symptoms in the first three months after back surgery are usually considered to have failed back surgery syndrome and further diagnostic procedures are often begun at this juncture. If there are signs of improvement then the patient usually continues to heal and has a successful outcome. Failure to achieve any alleviation of symptoms after a year indicates little success from the procedure as any nerve root damage would usually have healed by this time. If numbness, pain, and weakness do resolve, but the patient has persistent tingling and altered sensation in a nerve after a year these symptoms will not normally resolve even with further treatment for failed back surgery syndrome.
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