Failed Back Surgery Syndrome (FBSS): What It Is and How to Avoid Pain after Surgery
by Peter F. Ullrich, Jr., MD
Failed back surgery syndrome (also called FBSS, or failed back syndrome) is a misnomer, as it is not actually a syndrome. It is a very generalized term that is often used to describe the condition of patients who have not had a successful result with back surgery or spine surgery and have experienced continued pain after surgery. There is no equivalent term for failed back surgery syndrome in any other type of surgery (e.g. there is no failed cardiac surgery syndrome, failed knee surgery syndrome, etc.).
There are many reasons that a back surgery may or may not work, and even with the best surgeon and for the best indications, spine surgery is no more than 95% predictive of a successful result.
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, or
- 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.
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.
Therefore, the best way to avoid a spine surgery that leads to an unsuccessful result is to stick to operations that have a high degree of success and to make sure that an anatomic lesion that is amenable to surgical correction is identified preoperatively.
Other Causes of FBSS and Continued Pain after Surgery
In addition to the above-mentioned cause of failed back surgery syndrome, there are several other potential causes of a failed surgery, or continued pain after surgery:
- Fusion surgery considerations (such as failure to fuse and/or implant failure, or a transfer lesion to another level after a spine fusion, when the next level degenerates and becomes a pain generator).
- Lumbar decompression back surgery considerations (such as recurrent spinal stenosis or disc herniation, inadequate decompression of a nerve root, preoperative nerve damage that does not heal after a decompressive surgery, or nerve damage that occurs during the surgery).
- Scar tissue considerations (such as epidural fibrosis, which refers to a formation of scar tissue around the nerve root).
- Postoperative rehabilitation (continued pain from a secondary pain generator).
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