Failed Back Syndrome

Failed Back Syndrome (FBS)  or Post Discectomy/Laminectomy Syndrome refers to chronic back or neck pain that can occur after certain types of spinal surgery.This syndrome is not always due to a problem from surgery; different pain pathologies may be responsible for the pain that you are experiencing.While others simply hold surgeries responsible for Failed Back Surgery Syndrome, we get to the root of the problem and find out if degeneration of the spine or scar tissue could be the cause of your pain.  There is not a specific approach in treating failed back syndrome treatment, every person suffering from this condition is different and requires a unique treatment plan.  Some may benefit from electrical stimulation; others may benefit more from a regimented medical management plan.


Causes

Complications that arise from back surgery or the natural healing process that follows back surgery. Multiple factors can contribute to the onset or development of FBS. Contributing factors include but are not limited to residual or recurrent disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hyper mobility with instability, depression, anxiety, sleeplessness and spinal muscular deconditioning.


Risk Factors

Multiple factors can contribute to the onset or development of FBS. Contributing factors include but are not limited to residual or recurrent disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hypermobility with instability, scar tissue (fibrosis), depression, anxiety, sleeplessness and spinal muscular deconditioning. An individual may be predisposed to the development of FBS due to systemic disorders such as diabetes, autoimmune disease and peripheral blood vessels (vascular) disease. Smoking is a risk for poor recovery.


Symptoms

Common symptoms associated with FBS include diffuse, dull and aching pain involving the back and/or legs.Abnormal sensibility may include sharp, pricking, and stabbing pain in the extremities. The term “post-laminectomy syndrome” is used by some doctors to indicate the same condition as failed back syndrome.I see this usually in patients who have had a previous discectomy, and the disc degenerates further, becomes inflamed, and causes pain when loaded.


Diagnosis

Failed back syndrome is an imprecise term encompassing a heterogeneous group of disorders that have in common pain symptoms after lumbar surgery.  The most common diagnoses identified were spinal stenosis, internal disc disruption syndrome, recurrent/retained disc, and neural fibrosis.


Treatment

Your consultant will review your treatment history, particularly the type of surgery you had and the reasons for it. Particular attention is paid to the result of the surgery and the symptoms that have evolved following the surgery. A physical exam will be performed, and some further diagnostic tests may be ordered.The treatments of FBS include physical therapy, minor nerve blocks, transcutaneous electrical nerve stimulation (TENS), behavioral medicine, non-steroidal anti-inflammatory (NSAID) medications, membrane stabilizers, antidepressants, spinal cord stimulation, and intracathecal morphine pump. Use of epidural steroid injections may be minimally helpful in some cases. The targeted anatomic use of potent anti-inflammatory anti-TNF therapeutics is being investigated. Posterior Lumbar Interbody Fusion is effective in patients with a previous history of discectomy.

Epiduralysis using a catheter and enzyme can breakdown scar tissue causing pain.


Prevention

The best solution is prevention of unnecessary surgery.