Failed back surgery syndrome (FBSS) is not a specific medical condition.
It’s a general term used to refer to situations where patients do not experience the desired outcome following surgery performed on some part of the spine. FBSS is unique to spine surgery in the sense that this term cannot be applied to surgery for other purposes.
Part of the reason for this is because there are only two main purposes for spine surgery – decompression of a compressed, irritated, or pinched nerve or stabilization of the spine.
What Is Considered ‘Failed’ Back Surgery?
Spine-related surgery isn’t a “failure” simply because pain is still felt in the early days or weeks following spine surgery. Back surgery is usually considered unsuccessful if symptoms return or continue after an acceptable healing and recovery period.
What Causes Failed Back Surgery Syndrome?
The most common reason why back surgery is not successful is because there’s another source of discomfort that was overlooked or not diagnosed properly. The odds of experiencing FBSS will also depend on the specific procedure performed. A discectomy or microdiscectomy performed because of a herniated disc in the lower spine, for instance, has a much more predictable outcome than fusion surgery performed to address discs affected by degenerative disc disease at multiple levels. Contributing factors to FBSS may include:
- Instability that develops at another level of the spine post-surgery
- Technical errors that may have occurred during surgery
- Failure of a spinal fusion to form
- Attempting to return to certain activities too soon after surgery
- Undetected spine-related structural changes
What Are Options After FBSS?
According to research published in the Journal of Pain Research, nearly 75 percent of lower back procedures fail to completely relieve pain. While there is no standard protocol for what to do after back surgery fails, anywhere from 13 to 35 percent of spine surgery patients also have a revision procedure at some point. While there are some risks associated with opting for a second or third surgery, there is research suggesting that patients who do so often experience noticeable relief or complete elimination of symptoms.
What Are Options Other Than Revision Surgery?
Barring a medical emergency, revision surgery isn’t usually absolutely necessary with FBSS. In some situations, additional diagnostic testing may be done to determine if a primary or secondary source of spine pain exists that was not previously detected. This process may include nerve conduction studies and other more precise assessments. Other times, patients who did not have a good outcome after spine surgery may prefer to explore conservative (non-surgical) options before considering surgery again. Such efforts may include:
- Epidural injections or nerve blocks
- Chiropractic adjustments
- Spinal cord stimulation (SCS) devices
- Customized exercise routines
- Cognitive behavioral therapy
No matter how good a surgeon is or how reliable a certain procedure happens to be, no spine surgery has a 100 percent success rate. This being said, there are steps patients can take to increase their odds of responding well to various decompression or stabilization procedures. For example, having realistic expectations may reduce dissatisfaction levels if symptoms aren’t completely eliminated. It can also be beneficial for patients to actively participate in physical therapy and make positive lifestyle changes post-surgery with diet and exercise habits.