Definition
Failed Back Surgery Syndrome describes a patient’s persistent or newly emerging pain following one or more spinal procedures, such as laminectomy, discectomy, decompression, spinal fusion, etc.
Failed Back Surgery Syndrome
In such cases, pain typically begins three to six months post-operatively. Symptoms of this syndrome include widespread, severe pain in the back or legs, as well as pinching, stabbing, or similar sensations in the limbs.
Symptoms
Causes
Failed Back Surgery Syndrome may be the result of several factors, the most important of which are the following:
Wrong patient selection
This is the most common cause of Failed Back Surgery Syndrome. According to the relevant literature, patients with mental disorders, particularly anxiety or depression, patients with uncommon responses to pain, patients receiving Employment and Support Allowance, and patients involved in litigation tend to have poor surgical outcomes.
Incorrect or incomplete diagnosis
Failure to correctly identify the cause of pain can lead to the wrong choice of intervention, which does not address the problem. As a result, pain is still present even after the procedure.
Intra-operative medical errors
The most common medical error that can result in Failed Back Surgery Syndrome is the incorrect discectomy level. Identifying the level of spinal stenosis incorrectly, spinal fusion at the incorrect level, choosing a procedure type that does not address all of the patient’s complaints, or performing an inapplicable/inadequate surgical technique are examples of other medical errors.
Symptom recurrence due to a specific pathology
Post-operative symptom recurrence may be due to a progressive degenerative disease, or even a change in biomechanics due to the surgery.
Treatment Options
The choice of treatment – or combination of treatments – for Failed Back Surgery Syndrome is made after a thorough evaluation of the patient’s history, symptoms, causes, and mental state.
Drug Therapies
In many cases, pain management requires pain medications (analgesics) and anti-inflammatories. Additionally, opioids are occasionally used for short-term symptom relief, and some patients may benefit from a particular antidepressant and/or antiepileptic medication.
Epidural steroid injections
A corticosteroid and a local anesthetic are administered into the affected area’s epidural space during this procedure.
Nerve block
During a nerve block procedure, medication is injected directly into the nerve root or nearby to suppress pain signals.
Injections in myofascial pain trigger points
In this procedure, medicine is administered directly to a trigger point to relieve patient from pain.
Spinal cord stimulation
This technique is indicated for patients with Failed Back Surgery Syndrome who remain unresponsive to other pain management approaches. It is a minimally invasive technique, where a small device (neurostimulator) is implanted in the patient’s body and connected to electrodes implanted in the spine. This particular process alters the pain signals before they reach the brain, which helps patients experience less pain.
Intrathecal drug infusion with an implantable pump
Intrathecal drug administration via a “pain pump” is a method of administering drugs directly into the spinal cord.
Physiotherapy and Alternative treatments
Physiotherapy, chiropractic, transcutaneous electrical nerve stimulation (TENS), and electroacupuncture work as adjunct treatments for Failed Back Surgery Syndrome.
