Wednesday, April 10, 2024

What Are The Symptoms Of Failed Back Surgery

Successful Failure Failure Of A Successful Surgery Which One Are You

What is Failed Back Surgery Syndrome?

I would like to remind our readers that people have very successful spinal surgeries. These are the people that we do not see at our center, we see the people who did not. These simple stories go something like this:

Failed lumbar fusion at L5-S1

Dear Caring Medical, I have failed lumbar fusion at L5-S1. The fusion did not help alleviate my chronic pain which is sometimes severe and debilitating. Im hoping to eliminate or manage the pain in my back to allow for normal daily functioning like sitting, driving, walking, and standing.

The surgery was a success, but I still have pain

My surgeon said my L5-S1 fusion surgery was technically very successful. Unfortunately, scar tissue has developed and is pressing on my nerves.

My surgery was very successful, but I have spinal muscular atrophy as a result and weakness in my spine.

My surgery did not go well. I have had several surgeries since. I am on nerve blocks, pumps, pain meds.

When people contact us, we have to have realistic expectations that we can help them. We cannot help everyone. If someone has a hardware failure, such as a broken screw, a crooked rod, or any other hardware malfunction, the hardware issues need to be addressed with their surgeons before a discussion of avoidance of further surgeries can be discussed.

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, there are certain forms of back surgery that have a better success rate than others. For example, a discectomy does that have as good 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.

Treatment Options For Failed Back Surgery Syndrome

  • Facet Radiofrequency Neurotomy

    Facet radiofrequency neurotomy eliminates pain by preventing signals from injured nerves from reaching the brain. Can be used as treatment in the cervical and lumbar spine.

  • Facet Joint Injections

    Facet joint injections reat chronic pain by administering pain-killing medication directly to the source of the pain.

  • Steroid Injections

    Steroid injections reduce pain and swelling throughout the spine by delivering anti-inflammatory medication to the affected area.

  • Pain Pump

    A pain pump involves placing a small pump inside the body to steadily deliver pain-killing medication to the affected part of the spine.

  • Spinal Cord Stimulator

    A spinal cord stimulator is a small device placed inside the body that delivers tiny electrical pulses to the spine to relieve pain.

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Failed Back Surgery Syndrome: 5 Signs Youre Living With Fbss

Although generally referred to as failed back surgery syndrome or failed back syndrome, FBSS is best understood as any series of post-surgery complications, specifically in the case of spinal surgery. While post-surgery complications can occur after any surgery, failed back surgery syndrome has developed a reputation as a set of symptoms that, albeit rarely, occur in certain cases when a surgery either doesnt take, or if complications arise in the post-surgery healing process.

Despite the dangerous connotations of a failed back, FBSS is treatable. The key lies in diagnosing and recognizing it early enough to address any symptoms and treat the syndrome before it worsens.

What Is Failed Back Surgery

Pin on Medical

Self-evidently, failed back surgery is the outcome of surgical intervention that has been less than satisfactory in restoring a reasonable quality of life. This may be referred to as a multiply-operated back. In reality, these terms may be used as a mask to disguise the fact that the condition is normally deemed inoperable, that nothing else can be done, and that the final resort is to refer the patient for chronic pain management. There are some exceptions to this, but in terms of conventional surgery the available options are somewhat limited and include the following:

  • Where a residual or recurrent bone protrusion is deemed contributory and is safely accessible by conventional means. This can be treated by revision discectomy , with or without fusion at the same time.
  • Where a successful discectomy has been performed but over ensuing years additional degeneration in the disc and facet joint is deemed to be causing the patient discogenic pain or instability then this may be treated by open decompression and/or fusion.

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Failed Back Surgery Syndrome Symptoms

Before and after spine surgery the surgeon and other medical staff in charge of your care prepare you for recoveryand for many people, that is a long and challenging time. Pain after spine surgery is common, but how can you tell if its beyond the typical pain of recovery? What signs may indicate your spine surgery failed? Here, youll learn about the potential symptoms associated with failed back surgery syndrome or post-laminectomy syndrome).

The top complaint of people who have failed back surgery is chronic back pain. Photo By: Rawpixel on

Enhancing Healthcare Team Outcomes

interprofessional pain clinics are the gold standard in the setting of treatment for patients with complex chronic pain syndromes such as failed back surgery syndrome. The interprofessional care team in these clinics consists of pain physicians, nurses, psychologists, psychiatrists, physical therapists, pharmacists, and occupational therapists. The integration of different members of the healthcare team results in close communication between experts in distinct methodologies of treating chronic pain and promotes a biopsychosocial approach to the patients pain.

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Deterrence And Patient Education

Due to the noted difficulty of treating failed back surgery syndrome, avoiding the initial development of pain may be the most effective way of reducing the conditions burden on the general public. Reasonable non-operative measures including minimally invasive interventional treatments must be tried when indicated, before committing to an operative course. Poor selection of candidates for surgery or surgical technique is a common feature in the development of FBSS. Special care is necessary before performing operations for lower back pain in patients with psychiatric comorbidity. In the event of surgery, the most minimally invasive approach should be used to reduce damage to surrounding tissues, and errors such as wrong vertebral level, screw misplacement, inadequate decompression, or incomplete removal of tissue should be avoided.

Patients should receive proper education from a multidisciplinary team consisting of physicians, nurses, and physical therapists on possible risks and complications of lower back surgery before and after the operation. One study found that patients cited proper pre-procedure education and realistic setting of expectations as factors that increased their opinion of their surgeon even in spite of the development of chronic post-surgical pain. A team approach to education will provide the best possible patient outcome.

Signs & Symptoms Of Fbss

The Failed Back Surgery Syndrome

One common complaint physicians hear from patients is chronic back pain. However, not everyone experiences the same pain, and the type of pain they experience can vary, based on their spinal disorder, their previous procedure, or underlying cause of FBSS.

Other types of pain that can be associated with FBSS are:

  • Nociceptive Pain Localized pain that may be dull or sharp.
  • Neuropathic Pain Nerve-related pain is caused by damage to the nerves or spinal cord.
  • Radicular Pain Radicular pain radiates from one area to another

Other common symptoms of Failed Back Surgery Syndrome include:

  • Return of original symptoms & pain When the symptoms return that the original procedure was intended to correct, it may be a sign of FBSS.
  • Reduced mobility Recovering from back surgery is a process. However, if mobility is reduced or limitations arise that are different than predicted by your physician, it could be a sign of FBSS.
  • New problems arise While the original symptoms may be corrected by the surgery, new pain in a different part of the spine should be discussed with your doctor.
  • Onset of Headaches If headaches were not a part of your medical history prior to having surgery, this may be a sign of nerve damage after a spinal procedure.

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Hamstring Pain When Sitting

The hamstring is composed of the three long muscles that are found on the back of the upper leg. These are semitendinosus, semimembranosus, and biceps femoris. All three muscles run down the length of the thigh before they join together to become one tendon that attaches itself to the backside of the lower leg bone, called the Fibula. When these tendons contract it pulls the lower leg downwards towards our feet. The muscle contracts concentrically as it shortens. And relaxes eccentrically as it lengthens. This contraction action is also known as knee flexion. When these muscles are weak or injured it can be difficult to stand on

What To Do After A Failed Back Surgery

If youve had back surgery and youre still in pain, there is still hope. Keep reading to learn more about what to do after a failed back surgery.

Its important to understand the risks and benefits prior to undergoing any type of surgical procedure. Whether its minimally or extremely invasive, understanding each possible outcome you could encounter is essential. When you understand the risks and benefits, youll be able to make a fully informed decision.

As you probably know, every surgical procedure involves some level of risk. However, some surgical procedures have a higher failure rate than others. If you are preparing to have back surgery, you need to be aware that some procedures carry with them a high risk for FBSS, or Failed Back Surgery Syndrome than others.

For more information on what failed back surgery syndrome is , just continue reading.

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Diagnosing Failed Back Surgery Syndrome

The first step to diagnosing FBSS pain is to see a doctor for a physical exam. Motion, sensitivity, and strength help doctors decide the next steps to correctly diagnose the pain. Your medical history, pain levels, and previous treatments are discussed with your doctor to help them define the pain and decide on a treatment method.

Having tests like CT scans, MRIs, and X-Rays help doctors take an inside look at your pain. The images dont always show the root cause of the pain, making FBSS hard to diagnose.

Since imaging is not always reliable, doctors may use another form of testing to diagnose your pain. This is called an aware state surgical examination. A doctor uses a small probe and stimulates the spinal cord, mimicking the pain, and triggering a response from the patient. This informs the doctor as to what type of pain the patient is having and how it is caused.

Back pain patients are referred to pain management specialists who treat their pain and help improve their quality of life through short-term techniques.

Symptoms Of Failed Back Surgery Syndrome


If you suffer from back pain, youre not alone. Back pain is such a common problem in the U.S. that some studies have estimated that we spend about the same amount each year for back surgeries as we do for cancer treatments!

While some back surgeries do resolve patients problems, thats not always the case. In fact, continued pain after back surgery is so common that the medical professional has coined the phrase Failed Back Surgery Syndrome, or FBSS, and is a condition we see often at our pain clinic in Austin.

If you have undergone back surgery, but still suffer discomfort nonetheless, you could be experiencing FBSS. Here are a few symptoms to look for:

  • Significant, persistent pain in the back or leg that cannot be completely relieved by medication or physiotherapy.
  • Tingling sensation and numbness in hands, legs, feet or arms.
  • Weakness in legs and arms.
  • Depression and anxiety are often byproducts of the chronic pain brought about by FBSS. These conditions, in turn, can lead to abuse of alcohol or prescribed medications.

For more information, continue reading here.

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Failed Back Surgery Symptoms That Warrant Emergency Treatment

During spine surgery recovery, it may be difficult to identify whether your pain is within the bounds of normal. At scheduled follow-up appointments with your spine surgeon are a great time to check in and ask questions about the progress of your recovery and if any concerns exist.

Pain after spine surgery is normal, however, some signs and symptoms warrant emergency attention by your spine surgeon. If you experience any of the red flag symptoms below, call your doctor immediately

  • New weakness, difficulty walking, and electric-like pain in your lower body

  • Fever, vomiting, and/or unintentional weight loss

  • Loss of bowel or bladder function, which may be signs of a serious spinal nerve disorder called

Fusion Surgery & Failed Back Surgery Syndrome

Spinal fusion is one of the most common surgical procedures that doctors use to treat a myriad of abnormalities, including spinal deformities. Most often, a doctor performs this technique to treat both pediatric and adult scoliosis, as well as recurrent disc herniation. The goal of fusion surgery is to fuse two or more vertebrae together, increasing stability and reducing pain. This technique is especially effective in addressing scoliosis, as spinal fusion can actually reverse the lateral curvature of the spine. Sometimes, spinal fusion may even be used to help heal broken vertebra.

Spinal fusion is a popular treatment for good reason: it effectively provides pain relief and it usually works. However, as mentioned previously, there is no spinal procedure that guarantees 100% success. For spinal fusion, there is a perceivable correlation between the solidity of the fusion and positive results. While this may be, it is still possible for the patient to achieve relief even if the fusion is not solid. This result usually arises when the surgical hardware remains intact and the spinal stability is still good. Considering the goal of spinal fusion, this makes a fair bit of sense. Remember, the priority is not necessarily achieving a solid fusion. Instead, it is most important that the procedure achieves spinal stability.

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Fusion Failure After Spine Surgery

During fusion surgery, the measurement of success is primarily determined by spinal stability for the patient. If a solid fusion is not obtained but the hardware is intact and provides good stability, the patient may be free of back pain. On the other hand, a patient may experience significant pain despite the fact that a solid fusion was performed. Following this type of surgery, it can take anywhere from three months to a year to make a determination if the surgery was successful. For this reason, most surgeons will not consider further spine surgery if healing time has been less than a year. And only in certain cases where hardware has failed or if there is an obvious reason to do so, would back surgery be considered any sooner.

Years after a fusion surgery the patient may experience recurrent pain. This can happen due to a transfer lesion above or below where the successful fusion occurred. Transfer lesions are most likely to happen after a two-level fusion and are more common in degenerative osteoarthritis conditions, and less common in disc degeneration problems. Regardless, the nerve root can take a long time to heal from a fusion surgery, making the outcome difficult to predict.

Treating A Failed Back Surgery

5 reasons failed back surgery syndrome occurs

The treatment of a failed back surgery syndrome can be difficult for the patient and doctor. Generally, a multidisciplinary approach works best to help relieve symptoms. This includes the help of physical therapy, pain specialists, spine surgeons, and psychiatrists.

Similar to before the surgery, you want to make sure you have a thorough examination and appropriate diagnostic imaging. This includes the team accurately knowing the type, as well as how much pain you are experiencing.

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Do I Suffer From Failed Back Surgery Syndrome

Failed Back Surgery Syndrome is a generalized term assigned to those who have had back or spine surgery and have continued to experience pain after the procedure. This term is not an official syndrome within the medical industry. Instead, it is a growing designation among the crowd of sufferers for whom surgery didnt turn out the way they had hoped. In general, no surgery can provide a 100% success rate as there are many reasons a surgical procedure may not work. Even with the best surgeons and the best indicators, a predictive result can be assumed but never guaranteed.

Endoscopic Discectomy The Least Invasive Procedure Here Are The Patients It Wont Work For

Some consider endoscopic discectomy as the least invasive surgery for disc herniation. In this procedure, bones do not have to be removed, and muscles do not need to be moved out of the way. In January of 2020, a paper in the Journal of Spine Surgery examined independent risk factors to assess their correlation to sub-optimal outcomes after endoscopic lumbar discectomy.

Study highlights:

  • Analysis of clinical outcomes of 55 consecutive patients treated with endoscopic discectomy between June 2018 and March 2019
  • Primary outcome measures were postoperative reductions of the visual analog score graded on a scale of 1 to 10 for back and leg pain and modified MacNab criteria as well as time to narcotic independence.
  • Risk factors examined included smoking, facet disease, adjacent segments disc degeneration, obesity, alcohol abuse, and psychiatric illness.


  • 12.7% fair , and
  • 3.6% had poor , respectively.
  • The VAS scores for the back and leg pain reduced significantly.
  • Non-surgical treatments for spinal instability should be explored. Please see our article on Post-laminectomy syndrome for a discussion on that topic.

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