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Failed Back Surgery Syndrome

Failed Back Surgery Syndrome (FBSS) refers to persistent or recurring pain in the lower back or legs following spine surgery. Despite its name, the syndrome doesn’t necessarily imply a failed surgery but rather an unsatisfactory outcome.

Causes:

  1. Inappropriate Selection of Patients for Surgery: Not all back pain is suitable for surgical intervention.
  2. Incorrect Diagnosis: The initial cause of pain may have been misdiagnosed.
  3. Surgical Complications: Nerve damage, infection, or scar tissue formation.
  4. Recurrent Disc Herniation: The disc may herniate again at the same level.
  5. Adjacent Segment Degeneration: Degeneration of the spinal segments adjacent to the operated level.
  6. Spinal Instability: Fusion surgery can sometimes lead to instability above or below the fused segments.
  7. Psychological Factors: Depression, anxiety, and other psychological factors can affect pain perception and recovery.

Diagnosis:

  1. Clinical Evaluation: Detailed medical history and physical examination.
  2. Imaging Studies: MRI, CT scans, and X-rays to assess structural abnormalities.
  3. Electrodiagnostic Tests: EMG and nerve conduction studies to evaluate nerve function.
  4. Diagnostic Injections: Facet joint injections, nerve blocks, or discography to pinpoint the pain source.

Management:

  1. Non-surgical Treatment:
    • Physical Therapy: Tailored exercise programs to improve mobility and strength.
    • Medications: Pain relievers, anti-inflammatory drugs, muscle relaxants, and antidepressants.
    • Psychological Support: Cognitive-behavioral therapy (CBT) and counseling.
    • Injections: Epidural steroid injections, caudal or epidural neuroplasty, epiduroscopic adhesion release, nerve blocks.
  2. Surgical Treatment:
    • Revision Surgery: In some cases, another surgical intervention may be necessary to correct the problem.
  3. Spinal Cord Stimulator (SCS) Implant:
    • Role: SCS is used when conservative treatments fail. It involves implanting a device that sends electrical impulses to the spinal cord to mask pain signals before they reach the brain.
    • Procedure: The device is placed under the skin, and leads are positioned near the spinal cord. The patient can control the stimulation using an external remote.
    • Effectiveness: SCS can significantly reduce pain and improve quality of life for many patients with FBSS.

Prognosis:

  • Variable Outcomes: Prognosis depends on the underlying cause of FBSS, the patient’s overall health, and the treatments applied.
  • Success Rates: While SCS has shown promising results, individual responses can vary. Ongoing pain management and rehabilitation are often necessary.
  • Long-term Management: Many patients achieve a satisfactory level of pain control and improved functionality with a combination of treatments.

In summary, FBSS is a complex condition with multifaceted causes and requires a comprehensive, individualized approach to management. Spinal cord stimulation offers a valuable option for patients who have not found relief through other means. Connect with a trusted pain physician in Hyderabad for effective treatment options.

 

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