Failed Back Surgery Syndrome (FBSS), also known as post-surgical low back pain, refers to a condition where a patient continues to experience chronic pain and other symptoms after undergoing spinal surgery intended to alleviate their back pain or improve function. Essentially, it means the surgery did not achieve the expected results or the pain returned after an initial period of relief.
Over his 20 plus year career, Dr. Pathare has treated numerous patients that have been suffering with pain after neck or lower back surgery. Most of these patients have been to other pain management physicians. Many times, the patient’s have worsened pain after the spine surgery and are depressed. Some of these patients have had multiple surgeries. The surgeon has told the patient that the surgery went well however the patient is still suffering with tremendous pain and dysfunction.
The reasons for this may be due to incorrect diagnosis as to what is causing the pain. The source of the pain is not correctly identified.
Often this happens because other healthcare professionals focus on MRI findings without putting all the pieces of the puzzle together as to what is causing the problem.
Causes of Failed Back Surgery Syndrome:
FBSS can be caused by several factors, often related to the original surgery, the patient’s condition, or how the body responds to the procedure. Some potential causes include:
Muscular Causes such as Deep Trigger Points that were never properly identified and treated Before the surgery. Deep Trigger Points can occur after surgery and can be treated. Most Doctors Overlook this cause and instead push for highly invasive procedures or more surgeries.
Deep Trigger Points are areas of tight, hyperirritable muscle fibers that form within a muscle and cause pain in the local area or sometimes in another part of the body. These points are often deeper within the muscle tissue and are typically more difficult to reach than superficial trigger points. Trigger points are often associated with myofascial pain syndrome and can result from muscle overuse, poor posture, stress, injury, or other factors.
When pressure is applied to a deep trigger point, it may cause localized tenderness or a referred pain sensation in another area. This referred pain is one of the hallmark characteristics of trigger points, where pain is felt at a site distant from the trigger point itself. For example, a trigger point in the neck might cause pain, tingling, numbness in the head, shoulder, arm, or hand. Lower back trigger points can cause pain, tingling, and numbness that radiates down the leg, potentially mimicking sciatica/radiculopathy/ pinched nerve.
Incorrect Diagnosis:
If the original cause of the pain was misdiagnosed, surgery may not resolve the problem. For example, if the source of the pain was not related to the spine, such as in cases of muscle-related pain or visceral pain, surgery would not be effective.
Incomplete Resolution of the Underlying Problem:
The surgery may not have addressed the exact cause of the pain, leading to persistent or new symptoms. For example, if a herniated disc wasn’t fully removed or if spinal stenosis wasn’t completely relieved, pain can persist.
Surgical Complications:
Complications during or after surgery, such as infection, nerve damage, or incorrect spinal alignment, can lead to ongoing pain.
Scar Tissue Formation (Epidural Fibrosis):
After surgery, scar tissue can form around the nerves or surgical site, causing irritation and pain. This can lead to a condition called epidural fibrosis, which can mimic the symptoms of the original condition.
Adjacent Segment Disease:
When one part of the spine is surgically altered, the adjacent segments may experience additional stress, which can lead to degeneration and pain in those areas over time.
Degenerative Changes:
The spine can continue to degenerate after surgery, either in the same area that was treated or in other parts of the spine. For example, degenerative disc disease can progress, leading to new or continued pain.
Psychological Factors:
Chronic pain can be influenced by emotional and psychological factors such as depression, anxiety, or stress, which can affect a person’s perception of pain and contribute to long-term discomfort.
Post-Surgical Instability:
In some cases, surgery can result in spinal instability (for example, after a laminectomy or fusion), which can cause pain and discomfort.
Symptoms of Failed Back Surgery Syndrome:
The symptoms of FBSS can vary depending on the cause, but they typically include:
Persistent or recurring back pain: Pain that continues or reappears after surgery.
Leg pain: Pain, numbness, or tingling that radiates into the legs, which could be related to nerve compression.
Limited mobility: Difficulty bending, twisting, or walking due to pain.
Muscle weakness: Weakness in the legs or back muscles.
Sensation changes: Numbness or tingling in the back, legs, or feet.
Chronic discomfort: Even if the surgery provided initial relief, pain may return after months or years.
Treatment Options for Failed Back Surgery Syndrome:
Managing FBSS can be challenging, as it often involves a multi-disciplinary approach. Treatment options include:
Physical Therapy:
A well-structured physical therapy program can help strengthen muscles, improve posture, and increase flexibility. Therapy may also include exercises to improve spinal stability and reduce pain.
Medications:
Pain relievers, anti-inflammatory drugs (NSAIDs), or stronger medications like opioids may be prescribed for pain relief. Antidepressants or anticonvulsants may also be used if nerve pain (neuropathy) is involved.
Deep Trigger Point Injections ( Not Done by Most Pain Management Physicians)
Injections to eliminate pain from Deep Trigger Points which may have been the cause of the pain before surgery or have developed after surgery.
Epidural Steroid Injections:
Medial Branch Nerve Blocks:
Nerve blocks to identify and treat pain from nerves that supply the deep muscles of the neck and back and the facet joints.
Radiofrequency Ablation and Rhizotomy:
Needle based procedures that target the nerves that cause pain from the deep muscles of the neck and back and the facet joints. These procedures are done for longer term relief if the pain recurs.
Spinal Cord Stimulation (SCS):
A spinal cord stimulator is a device implanted near the spine to send electrical impulses to the spinal cord, masking pain signals and providing relief.
Reoperation or Additional Surgery:
In some cases, a second surgery may be considered to address any issues that weren’t resolved in the initial surgery or to correct any complications. However, this is often considered a last resort, as additional surgeries may carry higher risks.
Psychological Counseling:
Psychological support or counseling may be helpful to manage the emotional aspects of chronic pain, such as depression or anxiety, which can exacerbate physical symptoms.
Conclusion:
Failed Back Surgery Syndrome is a challenging condition, but it doesn’t mean all hope is lost after spinal surgery. Many individuals with FBSS can find relief with non-surgical interventions.
Call now for consultation with Dr. Pathare. This could change your life for the better.
