Failed Back Surgery Syndrome Treatment

What Is Failed Back Surgery Syndrome?

Failed back and neck surgeries can create a different condition called FBSS. So, what is failed back syndrome? This condition occurs when a patient has not had a successful result from the surgery and continues to experience continued or increased pain. It's a complex and multifaceted condition that can be physically and emotionally draining.

Common Risk Factors of FBSS

FBSS affects a diverse demographic. It is not limited to any specific age group, gender, or ethnicity but is more prevalent among those who have undergone spinal surgeries. Many factors contribute to unsuccessful surgery, such as smoking, uncontrolled diabetes, poorly performed surgery, or non-adherence to post-surgical instructions. But each patient is different, and each surgery is unique. At Pain and Spine Specialists, we can help establish the basis for continued pain and help you determine the best route forward.

Primary Pain Locations

The parts of the body affected by FBSS are primarily the back and neck, where the original surgery was performed. However, the syndrome can also cause pain in the extremities, particularly the legs. The pain can vary from mild discomfort to severe, debilitating agony, affecting quality of life and limiting everyday activities.

For the best results, it is crucial to understand the root cause of the pain to treat it appropriately. At Pain and Spine Specialists, we understand the challenges of living with FBSS and offer comprehensive care plans tailored to each individual's needs. Our dedicated team, led by Dr. Rao, is committed to helping you manage your pain and improve your quality of life.

Failed Back Surgery Syndrome Causes:

FBSS can occur due to a variety of reasons, here is an overview of failed back syndrome causes:

1. Recurrent Herniated Disc: Even after surgery, disc herniation can reoccur at the same spot, causing similar symptoms as before.
2. Scar Tissue Formation: The formation of scar tissue around the surgical area following a spine procedure. This scar tissue can compress the nerves, leading to pain.
3. Hardware Fracture: In some cases, the hardware used during spine surgery (like screws or plates) may break or move from its original position, causing discomfort and pain.
4. Inadequate Surgical Procedure: If the initial surgical procedure did not address the root cause of the pain or if the surgery was not performed correctly, FBSS could result.
5. Development of Post-Surgery Diseases: In some cases, patients may develop additional diseases in the post-surgery period. This could aggravate existing problems and cause FBSS.
6. Nerve Compression and Inflammation: Nerve compression and inflammation can occur due to the scarring and adhesion of tissue around the area of surgery.

Types of Failed Back/Neck Surgery Syndrome

There are multiple types of back and neck surgery. Here are some of the most common types of failed spine surgery and the possible complications for each:

Adjacent Segment Disease:

A spinal disorder that can result after spinal fusion. While it can develop due to the natural degeneration of the spine with aging, it is mainly known as a complication of spinal fusion, which is also performed more as people age. Suppose the spinal fusion was in the lumbar spine or lower back. In that case, that person may feel lower back pain, pain that radiates from the lower back into one or both legs/feet, neurological symptoms (tingling, numbness, or weakness), and pain while walking or difficulty getting up.

If the surgery was in the cervical spine or neck, that person may feel neck pain, pain radiating from the neck into the shoulders and arms/hands, and neurological symptoms (tingling, numbness, or weakness).

Failed Artificial Disc Neck Surgery:

Artificial disc replacement surgery can often be the course of treatment for severe disc herniation. Herniated discs alone do not usually cause pain, but they can cause compressed nerves when they bulge and press against the nerve. This bulging can lead to chronic pain, and an artificial disc is meant to correct this problem, but it can fail for several reasons. The artificial disc may cause a bone fracture to an already weak spine, or it may not have been made correctly or be the best fit for your spine, or it can make the bone in the spine erode and result in a misalignment with the vertebrae.

Failed Laminectomy Surgery:

A laminectomy is meant to relieve pressure on the spinal cord or nerves. During the procedure, the surgeon will make an incision on the back of the neck to remove a piece of bone on the back of the vertebrae, known as the lamina. While this can create more space in the spine to relieve that pressure, it can also make the spine less stable or possibly injure the nerves.

Failed Laminoplasty Surgery:

An alternative to a laminectomy, it is also meant to relieve pressure on the spinal cord or nerves. Instead of cutting away the lamina, the doctor cuts it to create a door-like hinge and inserts an implant to hold it in place.

When this type of surgery fails, it is often because the implants to hold the "door" in place did not work, there were progressive degenerative changes to the bone, and there was not enough decompression to be considered a success.

Failed Spinal Fusion:

Spinal fusions are one of the most common surgeries for back and neck pain relief. During a spinal fusion, a surgeon removes the spinal disc between two or more vertebrae, then fuses the vertebrae with bone grafts or metal devices with screws to create a single, stable piece of bone.

Spinal fusion treats a wide range of issues that lead to chronic pain, including degenerative disc disease, spondylolisthesis, spinal stenosis, scoliosis, fractured vertebrae, infection, herniated discs, and tumors. Failed lumbar fusion symptoms are often a loss of flexibility and failure if the bone grafts or metal are insufficient to hold the spine while it fuses and heals.

Failed Spinal Implant Surgery:

Many types of spinal hardware are implanted to correct issues with the spine that cause chronic neck and back pain. Spinal implants support the spine or replace parts that may be too worn away from age or degenerative disease. Spinal implants can fail due to the hardware eroding or breaking, fractures occurring in the spine's bones, the implant dislodging or not being correctly placed, or the implant is not the appropriate choice for that patient.

Arachnoiditis:

A rare but painful condition occurs when one of the three membranes surrounding and protecting the nerves of the spinal cord, called the arachnoid, becomes inflamed.

Epidural Fibrosis:

This refers to the formation of scar tissue around the surgical area following a spine procedure. This scar tissue can compress the nerves, leading to pain.

Failed back syndrome symptoms

Those who have had a failed back or neck surgery generally experience the same symptoms they had before surgery. Usually, they do not see any improvements in their pain, and some people experience worse pain immediately or shortly after surgery.

Here are common signs and symptoms of Failed Back Syndrome:

1. Persistent or Increased Pain: Despite undergoing surgery, patients may experience pain in the back, neck, or legs. This pain can be similar to or worse than the pain they experienced before the surgery.
2. Restricted Mobility: Patients may find it difficult to move freely due to stiffness or discomfort in the back or neck area.
3. Numbness or Tingling Sensation: Some patients may experience a numb or tingling sensation in their extremities. This is often due to nerve damage or inflammation.
4. Depression or Anxiety: Chronic pain can lead to emotional distress, including feelings of depression or anxiety.
5. Sleep Disturbances: Persistent pain and discomfort can also disrupt sleep, leading to insomnia or other sleep disorders.

Each patient's experience with FBSS can vary, and not all patients will experience all these spinal fusion failure symptoms. If you're experiencing persistent pain after spine surgery, it's crucial to consult with a back pain specialist to determine if you may have failed spinal surgery syndrome.

Diagnosing Failed Back Surgery Syndrome

Diagnosing Failed Back Surgery Syndrome (FBSS) is a meticulous process that involves a comprehensive evaluation of your symptoms, medical history, and physical examination. At Pain and Spine Specialists, our back pain doctors are committed to accurately diagnosing FBSS to ensure the most effective treatment plan.

Our diagnosis begins with a detailed discussion about your symptoms, the nature of your previous surgery, and how your life has been affected post-surgery. We delve into specifics like the type and location of your pain, its severity, and factors that alleviate or aggravate it.

Next, we conduct a thorough physical examination. This includes checking for areas of tenderness, range of motion, loss of sensation, signs of nerve damage, and muscle weakness.

Imaging tests also play a crucial role in diagnosing FBSS. These may include X-rays, CT scans, and MRIs, which can provide a detailed view of your spine and help us identify any issues causing your pain. In some cases, a discogram - an invasive procedure that helps determine if one or more discs cause back pain - might be recommended.

Finally, we may also use nerve conduction studies or electromyography to assess the electrical activity in your nerves and muscles.

Our intensive diagnostic process aims to pinpoint the exact cause of your pain, so we can create a personalized treatment plan that targets your specific needs and helps you regain functionality.

Failed back surgery syndrome treatment

At Pain and Spine Specialists, our approach to treating Failed Back or Neck Surgery Syndrome is comprehensive and personalized. We use a combination of injection therapies, advanced interventional procedures, conventional treatments, and alternative therapies. Some failed back syndrome treatments include:

Injection Therapies for FBSS

Injection therapies can provide immediate relief from pain and inflammation. Specifically for FBSS, we often use:

• Epidural Steroid Injections: These injections deliver steroids, which are powerful anti-inflammatories, directly into the epidural space in your spine. They help reduce inflammation around the nerves, relieving pain.
• Facet Joint Injections: Facet joints are small joints at each segment of the spine that provide stability and help guide motion. If these joints become inflamed, they can cause significant pain. Facet joint injections can help reduce this inflammation and provide pain relief.
• Sacroiliac Joint Injections: The sacroiliac joints link your spine to your hip bones. Similar to facet joint injections, these injections can help reduce inflammation and alleviate pain.
• Medial Branch Blocks: These injections target nerves that carry pain signals from the facet joints to the brain. By blocking these nerves, medial branch blocks can provide temporary relief from back pain.

These injections can help reduce inflammation around the nerves and joints in your spine, relieving pain.

Advanced Interventional Procedures:

For more severe cases of FBSS, we may recommend advanced procedures like:

• Spinal Cord Stimulation: This involves implanting a device that sends electrical signals to the spinal cord, helping to mask pain signals before they reach the brain.
• Minimally Invasive Lumbar Decompression (MILD): This procedure removes bone or ligament material that is pressing on the nerves, relieving pain and improving mobility.
• Radiofrequency Ablation: This treatment uses heat generated by radio waves to disrupt nerve function, preventing the nerves from sending pain signals to the brain.
• Intrathecal Pain Pump: This involves implanting a device that delivers pain medication directly to the fluid around the spinal cord, providing effective pain relief with lower doses of medication.
• Peripheral Nerve Stimulation: Similar to spinal cord stimulation, this involves implanting a device that sends electrical signals to the peripheral nerves, helping to mask pain signals.
• Sacroiliac Joint Fusion: This surgical procedure fuses the sacroiliac joint, reducing pain and increasing stability.

These procedures can help manage chronic pain, improve mobility, and enhance overall quality of life.

Conventional Treatments for FBSS

Alongside these treatments, we offer conventional therapies like:

• Medication Management Programs: These programs involve the use of various medications to control pain and inflammation. This can include Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), muscle relaxants, and neuroleptics.
• Referrals for physical therapy: Physical therapy can play a crucial role in managing FBSS. It helps improve mobility, strength, and function and can also alleviate pain.

Alternative Therapies for FBSS

We believe in a holistic approach to pain management. Therefore, we also offer alternative therapies through our sister company, Shakthi Health and Wellness Center. These include treatments like:

• Acupuncture: While not traditionally part of Western medicine, acupuncture has been found to help some people with FBSS. It's believed that acupuncture stimulates the body's natural ability to heal itself and encourages the release of endorphins, the body's natural painkillers.
• IV Therapy: Intravenous (IV) therapy enables direct delivery of nutrients and medications into the bloodstream. This method ensures maximum absorption and can be used to deliver anti-inflammatory medications or other treatments that help manage FBSS symptoms.
• Photobiomodulation: Also known as Low-Level Laser Therapy (LLLT), photobiomodulation is a non-invasive treatment that uses light to stimulate cell regeneration and increase blood circulation. It has been shown to have an analgesic effect and can be used to manage pain associated with FBSS.

These treatments can often complement your primary treatments and contribute to better long-term recovery outcomes.