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Failed back surgery syndrome (FBSS) is a chronic pain condition that features persistent or recurring low back pain after one or more spinal surgeries. In general, the term FBSS is used mainly to describe patients with ongoing pain after surgery of the lumbar spine for degenerative disc disease. The pain may radiate to the lower limb. Furthermore, there is no indication of macroscopic pathology that could justify a reoperation. Recent studies have revealed that FBSS patients experience greater levels of pain, lower quality of life, greater disability and a higher rate of unemployment, with a significant economic impact.
Failed back surgery syndrome (FBSS) is complex and recurrent chronic pain after spinal surgery. Several important patient and surgery-related risk factors play roles in the development of FBSS. Inadequate selection of the candidates for the spinal surgeries is one of the most crucial causes. The guidelines suggest that conservative management featuring pharmacologic approaches and rehabilitation should be introduced first. For therapy-refractory FBSS, spinal cord stimulation (SCS) is recommended in selected patients. Treatment efficacy for FBSS has increased over the years with the majority of patients experiencing pain relief and reduced medicinal load. Improved quality of life can also be achieved using SCS. Cost-effectiveness of SCS still remains unclear. However evidence for SCS role in FBSS is controversial, SCS can be beneficial for carefully classified patients.
Reasons for Failed Back Surgery and Pain after Surgery
Spine surgery is basically able to accomplish only two things:
- Decompress a nerve root that is pinched
- Stabilize a painful joint
Unfortunately, back surgery or spine surgery cannot literally cut out a patient’s pain. It is only able to change anatomy, and an anatomical lesion (injury) that is a probable cause of back pain must be identified prior to rather than after back surgery or spine surgery.
By far the number one reason back surgeries are not effective and some patients experience continued pain after surgery is because the lesion that was operated on is not in fact the cause of the patient’s pain.
Predictability of Pain after Surgery
Some types of back surgery are far more predictable in terms of alleviating a patient’s symptoms than others. For instance:
- A discectomy (or microdiscectomy) for a lumbar disc herniation that is causing leg pain is a very predictable operation. However, a discectomy for a lumbar disc herniation that is causing lower back pain is far less likely to be successful.
- A spine fusion for spinal instability (e.g. spondylolisthesis) is a relatively predictable operation. However, a fusion surgery for multi-level lumbar degenerative disc disease is far less likely to be successful in reducing a patient’s pain after surgery.