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:
- Inappropriate Selection of Patients for Surgery: Not all back pain is suitable for surgical intervention.
- Incorrect Diagnosis: The initial cause of pain may have been misdiagnosed.
- Surgical Complications: Nerve damage, infection, or scar tissue formation.
- Recurrent Disc Herniation: The disc may herniate again at the same level.
- Adjacent Segment Degeneration: Degeneration of the spinal segments adjacent to the operated level.
- Spinal Instability: Fusion surgery can sometimes lead to instability above or below the fused segments.
- Psychological Factors: Depression, anxiety, and other psychological factors can affect pain perception and recovery.
Diagnosis:
- Clinical Evaluation: Detailed medical history and physical examination.
- Imaging Studies: MRI, CT scans, and X-rays to assess structural abnormalities.
- Electrodiagnostic Tests: EMG and nerve conduction studies to evaluate nerve function.
- Diagnostic Injections: Facet joint injections, nerve blocks, or discography to pinpoint the pain source.
Management:
- 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.
- Surgical Treatment:
- Revision Surgery: In some cases, another surgical intervention may be necessary to correct the problem.
- 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.
