Failed Back Syndrome

Low back pain is a major cause of disability and poor quality of life. Failed back syndrome is also called failed back surgery syndrome. Failed back syndrome is where the outcome of lumbar spine surgery doesn’t meet the expectations of the patient and the surgeon, and usually implies multiple prior surgeries to address back pain. The syndrome is most common in people with lumbar spinal stenosis and disc herniation.

Failed back syndrome is defined as lumbar spine pain of unknown origin that either persists despite surgery or appears after surgery in the same area as the surgery. The pain may originate after surgery, or surgery may worsen or insufficiently eliminate existing pain. It is a syndrome with many causes, diagnosed by a constellation of symptoms and physical findings. The direct cause is not known.

Pain with failed back syndrome is often severe, interfering with work and quality of life. It is generally not a consequence of surgery that was performed incorrectly. In fact, even with the best surgeon and the best indications, spine surgery does not always predict successful resolution of the condition or the pain that it causes. 

There are many factors that are associated with failed back syndrome.

  • The patient’s psychological and social wellbeing have a significant effect on their treatment outcome and pain experience. Patients who are obese or smokers have a higher rate of postoperative complications.
  • Some patients have poor outcome due the fact that the patient was not a good surgical candidate or because the choice of surgical procedure was inappropriate.
  • Patients with multiple prior back surgeries have a higher chance of developing failed back syndrome and a lower chance of achieving successful pain resolution with more surgery.
  • Surgical risks include operating at a single level when pain originates at multiple levels and operating at the wrong level.
  • Postoperative factors include long term complications of surgery. Altered biomechanics can shift stress to other lumbar segments and lead to new sources of pain and accelerate degeneration.

Dallas Neurosurgical & Spine neurosurgeons will work with a multidisciplinary team to evaluate all factors that could have contributed and may be continuing to contribute to your current circumstance. This will include an evaluation of your psychological and social wellbeing, along with a detailed analysis of your pain history and previous treatments.

An accurate history and thorough physical exam are essential to evaluate patients with persistent pain after low back surgery for a correct diagnosis. Imaging studies include x-rays to assess spinal alignment, and degenerative changes as well as the extent of previous surgeries. MRI is the gold standard to distinguish physical sources of pain. Diagnostic nerve blocks can help diagnose specific causes of failed back syndrome, and when combined with steroids can provide relief.

Treatment is focused on patients who are unlikely to benefit from further surgical intervention and for patients who do not require immediate surgery.

Conservative management involves a supervised exercise program (physical therapy) to improve core strength and spinal range of motion, plus pain management. Pain management will include the use of over-the-counter and prescription anti-inflammatory medications, and antidepressants. Opioids are only used for short-term therapy. Anticonvulsant medications like gabapentin and/or pregabalin may be ordered for nerve pain.

Spinal cord stimulation has proven effective for limb pain. Called neuromodulation, spinal cord stimulation is a minimally invasive surgically implanted spinal column stimulator that is placed when further surgery is deemed to offer no further benefit and the patient receives optimal medical management.

Dallas Neurosurgical & Spine neurosurgeons will choose the most appropriate treatment modality based on the patient’s type of pain and pain pattern. Contact us to receive the correct diagnosis and all your treatment options.

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