Failed Back Surgical Syndrome
Written by Nicole Mongelli
Failed Back Surgical Syndrome is a broad diagnosis describing a patient that has symptoms of pain following some type of spinal surgery. This might be confusing and may seem to imply that the surgery wasn’t a success. However, oftentimes we see that the surgery has, in-fact, been successful at correcting the problem or abnormality. Unfortunately, even when post-surgical imaging shows that the problem was corrected and that the surgery was a complete success, the patient will still continue to have pain. This chronic pain condition is known as failed back surgical syndrome, and can be a result in as many as 40% of spinal surgeries.
So, what qualifies post-operative pain as failed back surgical syndrome? It is completely natural to have healing pain after the surgery. Additionally, it may take some time for the prior pathology to heal itself following surgical repair. Approximately 90% of the healing will occur within the first 6 months, additionally some small improvement will likely continue for up to 2 years. Given these timeframes, the failed back surgical syndrome diagnosis is usually not made until at least 6 months following surgery.
The term “failed back surgical syndrome” can be very broad and include several types of post-operative pain complaints after undergoing multiple types of back surgeries. We can break this down into three of the most common issues; adjacent segmental disease, chronic nerve damage and mixed pain syndrome.
Adjacent segmental disease is common when you have stabilizing hardware placed, or a spinal fusion performed. Rarely will we see any breakdown between the two segments that have been stabilized and secured however, we find that in the spinal segments immediately above and below the fusion, the discs and facet joints are working harder to make up for the lack of mobility from the spinal hardware in place. These segments may wear down sooner and develop discogenic disease or facet joint arthropathy quicker than normal as they are forced to work harder due to the fused segments nearby.
Treatments to relieve pain from adjacent segmental disease may include more conservative procedures including Osteopathic Manipulative Medicine (OMM) or formal physical therapy. Additionally, minimally invasive interventions such as epidurals, nerve blocks, cortisone shots or radiofrequency ablations are also utilized . There are also new treatments such as Vivex (an allograft that rehydrates the disc) and Intracept (ablating the basilar vertebral nerve), as well as the option to surgically extend the fusion to those segments, or fusion/stabilization of other joints such as the sacroiliac (SI) Joint.
Chronic nerve damage may be the culprit when patients have had a prior pinched nerve or lumbar radiculopathy. Patients may undergo a surgical nerve decompression which will remove any mechanical pressure or pinching. Afterwards the patient may continue to feel very painful following a successful surgical repair. This can be a result of the extended amount of time that the pressure was on that particular nerve root or if it is unable to heal or recover completely.
If the neuropathic pain does not subside after that 6-month marker, one of the most effective ways to relieve that pain is with spinal cord stimulation. This procedure puts a small amount of electrical stimulation over the spinal cord replacing that pain signal to the brain with a soothing and relaxing sensation, or even resulting in no pain sensation at all.
Mixed pain syndrome is a combination of mechanical back pain where the patient feels pain when bending, twisting or moving and a radicular or neuropathic pain that is ongoing regardless of movement or rest. These cases are much more complex, and we find that the one of best treatments for this can be intrathecal pain pumps. These devices are useful at delivering pain relief without the side effects of oral medications. The pump delivers medication directly to the intrathecal space relieving both neuropathic and mechanical back pain.
The key to relieving pain following back surgery is to see a physician for a discussion of what your specific problems are and obtaining the proper diagnosis. Identifying the correct diagnosis and matching it with the most appropriate course of treatment gives us the best opportunity for pain reduction. There are many options available and you should never feel that you are bound to a life of chronic pain.