Failed Back Surgery Syndrome
Clearwater, Tampa, St Petersburg, Florida
Failed Back Surgery Syndrome, sometimes referred to as post laminectomy syndrome, refers to patients who have not responded to surgical intervention to relieve back pain.
The diagnosis Failed Back Surgery Syndrome itself is considered a “wastebasket” diagnosis, meaning the diagnosis does not add any insights into the patient’s medical condition, other than the fact that surgery did not relieve their pain.
At best, this wastebasket diagnosis gives the patient and physician a convenient label for talking about the patient’s problems while they attempt to address the root problem(s). At worst, the existence of the label results in the patient and physician treating the label instead of treating the patient’s actual problems.
What exactly does this diagnosis imply? Is failed back surgery syndrome (lack of improvement following surgical intervention) a separate condition that a patient suddenly develops if pain continues after the surgery? Another question can also be entertained: Was the surgery anatomically specific in addressing one problem, or was the majority of the patient’s pain actually arising from another pain generator site, leading to an unnecessary surgery?
In the United States, the surgical success rate for back surgery is 50 percent. In Europe, the surgical success rate is much higher because they are less inclined to operate on people with back pain and are more stringent regarding who should have back surgery. Lastly, surgery can cause scar tissue formation and adhesive fibrosis around the nerves and spine. Post-operative infection from screws and plates used in spinal fusion can lead to a whole host of new problems.
As an illustration, consider a surgery performed on a diagnosed disk herniation. The surgeon may be meticulous and precisely remove the disk material that has herniated. The postoperative course is unremarkable with no complications, yet low back pain remains. Does this automatically mean the patient has a new condition, one bearing the descriptive term failed back surgery syndrome? Literally speaking this would be correct, because we now know that the condition the patient has does not respond to surgical intervention. However, this does not give us any new insight into what is wrong with the patient. The best direction at this point is for a physician skilled in rehabilitation and pain management to identify additional factors that are causing the patient’s pain to continue, despite the back surgery.
If additional factors are identified, these areas can be treated to reduce the pain. Having the diagnosis of failed back surgery syndrome does not mean the patient has to accept their condition as permanent.
Now, having said all that, there are conditions or situations that could accurately be considered failed back surgery syndrome:
- Massive herniated disks pressing on nerve roots can result in permanent injury to the nerve
- Post-operative scarring can cause arachnoiditis, an inflammation of the arachnoid lining – one of the three delicate, web-like membranes that cover the spinal cord and brain. Advanced spinal stenosis or chronic degenerative disk disease can also cause arachnoiditis.
- Spinal levels adjacent to the surgical site that are “involved”, but not addressed during the surgery.
- Re-herniation of the disk addressed during the surgery is a possible complication.
Frequently, other problems may cause pain and may even be the major source of the pain in failed back surgery syndrome, but are problems that surgery cannot affect.
- Bony pathology such as inflamed or irritated facet joints are a frequent site of pain. This is a nonsurgical condition easily addressed and treated by a skilled physician.
- Muscle problems (which are extremely common in chronic low back pain) are often overlooked, as muscle problems cannot be identified in imaging studies such as MRI, and require a careful examination. Myofascial pain syndrome and fibromyalgia are chronic muscular pain syndromes often overlooked and are unaffected by surgical procedures.
With chronic pain, muscle pain and tightness are frequently present. To tailor a comprehensive rehabilitation program for the patient, it is essential to identify these painful areas. Such a program is critical to reducing pain and preventing unnecessary and ineffective treatment from continuing for months and years. This is especially true for the patient who has been identified as having failed back surgery syndrome.
A patient who continues to suffer pain after not responding to surgery (which is often the “final hope” that failed to deliver), can and often does develop other long-term problems, such as: anxiety, depression, loss of sleep, interpersonal relationship problems, and discord with family and friends. These problems (and others) all reduce a person’s capacity to deal effectively with pain. Poor coping strategies ensue such as abusing medication and/or alcohol, and withdrawing behaviors. These problems further complicate the picture. Financial problems can heighten the situation, causing mounting stress without identifiable solutions.
Recently, laser spine surgery has received great attention. The laser is very limited in what it can do because there is limited access to the spine. Since the inter-vertebral discs are in front of the spinal cord, trying to laser a herniated disc from the posterior approach means the surgeon has to go around the spinal nerves to reach the herniated disc. Accidently nicking the spinal cord or nerves with a laser would end in tragedy. This is why you have not seen laser spine surgery on 60 Minutes as the panacea for curing back pain – it technically can’t. Additionally, many patients have other problems that a laser cannot address, such as myofascial pain (painful trigger points or knotted muscles), not just “back pain.”
A physician experienced in addressing and treating all potential sources of a patient’s pain is needed to develop and implement a treatment plan that will be successful, especially for a patient that has failed back surgery syndrome.
If you suffer with failed back surgery syndrome and your current treatment plan leaves you feeling frustrated, perhaps a fresh set of experienced eyes can change your outlook. Since 1990, Dennis M. Lox, M.D has applied his personal interests in sports medicine, cutting-edge regenerative medicine and chronic pain management to helping patients increase their quality of life. Contact us for an appointment at 727-462-5582.
Dennis M. Lox, MD, and the Florida Spine Center serve patients within the greater Tampa Bay area, including Clearwater, Tampa and St. Petersburg, as well as all of Florida and the US.
All statements, information or opinions provided by this website are provided for educational purposes only. We do not diagnose nor treat through this website or by telephone. As you consider any treatment, discuss them with your physician.