FAQ’s on Failed Back Surgery

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What is Failed Back Surgery?

Each year over 600,000 people in America undergo back surgery, according to the statistics published by the National Institute of Health. Of this number, a certain percentage may face failed back surgery, typically 20-30%. This means that the surgery designed to correct the problem, did not provide the results expected. People who experience failed back surgery are faced with chronic pain and symptoms they had prior to the surgery, and in some cases, the symptoms worsen.

What Causes Failed Back Surgery?

Pain-free-picture1-300x153There are several causes for failed back surgery. The first cause typically involves the reason behind the original surgical procedure. In these cases, the patient did not have the proper surgery in order to fix the problem. For example, a patient may have been diagnosed with degenerative disc disease but the surgical procedure provided did not correct the problem, because another issue was actually going on. Or possibly the procedure only got rid of half the pain, leaving the patient with continued chronic pain.

The second cause for failed back surgery involves the procedure itself. Possibly the surgeon did not perform the procedure correctly. The end result is a failed back surgery resulting in pain and severe discomfort.

The third cause for failed back surgery simply involves time and overall wear-and-tear around the surgical site. A patient may have a favorable outcome following surgery but over time degeneration around the surgical site may occur. The break down may take up to one or two years to occur, but results in persistent back and/or leg pain.

A fourth cause is not actually failed back surgery, but a situation where the back fusion failed and needs a revision procedure. It is quite possible the correct procedure was performed and done very well, however, the fusion did not finish. In that situation, a revision would possibly help.

What Are the Symptoms Related to Failed Back Surgery?

The most common symptom associated with failed back surgery is persistent back pain. Multiple outcomes for failed back surgery include chronic and persistent back pain, burning pain in the back of the leg, and numbness in the back or leg. The symptoms usually act in combination with one another and provide significant pain and discomfort for the affected patients.

How is it Diagnosed?

Back-pain1Determining the cause for persistent pain is challenging in patients with failed back surgery. Your pain management doctor will require a complete physical examination along with a complete medical history. You will discuss the reason for your back surgery along with the symptoms you currently have. If you have kept a pain journal, your pain doctor will want to look at it to gather further insight into your condition.

X-rays or a CT scan can reveal further information regarding the surgery. If there was a problem with the procedure, the scans may show the reason why (such as a failed fusion with broken hardware). An MRI may help show if nerves are being pinched.

Even if no official reason can be elucidated for the failed back surgery, if no additional anatomical reason can be seen for the back pain, then the diagnosis of failed back surgery is a safe bet.

What are the Treatments for Failed Back Surgery?

Spinal-Cord-Stimulator2Treatment for failed back surgery is contingent on the cause for back surgery. It is critical that the pain management specialist be aware of why surgery was needed and why the individual experiences chronic pain.

There are cases of back surgery where the results of the procedure were favorable but the patient continues to have pain. A small percentage of individuals with failed back surgery report symptoms of pain that radiates down the back of the leg. The doctor will examine for additional herniation or scar tissue buildup that is causing compression and further pain.

Treatment options for failed back surgery syndrome include:

  • Over the Counter Pain Medications (NSAIDS, Tylenol)
  • Short Term Opiates
  • Membrane Stabilizing Medications – for Neurogenic Pain in the legs
  • Physical Therapy – ice/heat, electrical stimulation, ultrasound
  • Chiropractic Adjustments
  • Spinal Decompression Therapy – as long as no instrumentation is present
  • TENS Unit
  • Interventional Pain Management – Trigger Point Injections, Facet Injections, Medial Branch Blocks, Radiofrequency Ablation, Epidural Steroid Injections, Spinal Cord Stimulator Implant (Ross, et al., Spine, 2008)

What are the Outcomes?

Reasonable expectations for back surgery are needed in most cases. Unless there is a definitive problem that can only be corrected by surgery, undergoing another surgery to eliminate pain may be unreasonable. People who undergo surgery on their back to reduce symptoms of pain and discomfort must be aware that a 100% pain-free outcome may not be possible. Many patients understand that their pain may be reduced by 25% or more, but do not expect to be completely pain free.

With the above treatments that are individualized to patients with FBSS, it is possible to dramatically reduce the patient’s baseline chronic pain. Spinal cord stimulator implants have been shown to work well for chronic pain over 75% of the time if the treatment is initiated within 2 years of the pain starting. Granted, the stimulator is not going to fix the problem. But if it is not fixable, then masking the pain is in order.

Patients with reasonable expectations can get back to a much better life after they receive treatment for failed back surgery. Chronic pain can be managed with the help of an experienced pain management specialist. The treatment may make it possible for the patient to return to work, avoid depression and mood disorders, and allow them to get back to a normal and productive daily life.