Failed back syndrome is a general term that describes patients who have undergone prior spine treatment or surgery – yet they continue to experience chronic back or neck pain, with or without extremity pain.
There are other names for it. Failed back surgery syndrome (FBSS) in it’s long form, or post-laminectomy syndrome, although a patient’s prior spinal surgery may have involved a different procedure other than a laminectomy. Regardless of what it is called, failed back syndrome is confusing as it is not a syndrome but a general medical term used to describe the condition.
This situation is frustrating for patients – not only does their back still hurt, but they also feel like they are right back where they started before their surgery.
Surgery for back pain is appropriate when there is an identifiable pain source – usually to decompress a pinched nerve root or to stabilize a painful joint. However, back pain can have several different concurrent causes, and accurate identification of pain sources is a complicated process.
In many cases, symptoms won’t evidence themselves clearly with imaging from an x-ray or MRI alone. Usually your doctor will have to use multiple diagnostic approaches to clarify your condition.
After prior spinal surgery, the condition can take different forms. It could be the result of a new and unrelated spinal problem after surgery. Or the surgical procedure may have gone well, but the original pain still does not go away. Or a complication may have developed, such as infection, nerve injury, or failure to heal.
There are also cases where the long-term use of narcotic pain medications before surgery has changed how the brain interprets a sensation as being painful or not.
Multiple factors can contribute to the development of failed back syndrome, including:
- Recurrent spinal disc herniation
- Persistent pressure on a spinal nerve after surgery
- Altered joint mobility and scar tissue (fibrosis)
- Pre-existing conditions, such as diabetes, autoimmune disease, and vascular disease
The most crucial first step you can do is go through a thorough reassessment of your situation and rediagnosis with an expert who is experienced in evaluating this condition.
Physical exercise and rehabilitation and non-steroidal anti-inflammatory medications are critical components of a multi-element treatment plan for persistent spinal pain. However, if the pain becomes too severe or doesn’t respond to this treatment, a more detailed evaluation should be conducted.
Spinal pain can be diagnosed and treated by fluoroscopically guided injections. These can include minimally invasive procedures such as an epidural steroid injection or a radiofrequency neurotomy. Neurological pain can also be treated with a targeted injection of anti-inflammatory medication around the affected nerve.
In situations where a patient doesn’t respond to advanced medications, treatment with neurostimulation, such as an implanted spinal cord stimulator, may be effective in controlling these symptoms.