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The term being used for patients who have continued symptoms and pain after undergoing spine surgery is Failed Back Surgery Syndrome. Most traditional open back surgeries, like spinal fusions, can often result in FBSS; it is estimated that as many as 60% may encounter it. Its high incidence has resulted in the problem being labeled as a syndrome, reflecting its importance and the problems in managing it.
The Anatomy of the Spine
To understand the causes and mechanisms behind FBSS better, one needs to know how the human spine is structured. The spine contains 33 vertebrae, structured in different parts: the cervical, or neck; the thoracic, or the mid-back; and the lumbar, or the lower back, with the sacral and coccygeal, or tailbone, regions. The intervertebral discs are located between the vertebrae and work to cushion the vertebrae during activities such as jumping and running. Each disk is composed of two parts: the annulus and the nucleus. The anatomy of the spine is very complex, and thus the latter is prone to different types of injuries, degenerative conditions, and disorders that may cause back or neck pain.
What is Failed Back Surgery Syndrome (FBSS)?
FBSS occurs when a patient still feels the pain or has some other complication after being operated on for spine surgery. This means that even after undergoing surgery, the patient can experience continuous pain or additional complications adding to the problems. The effect of FBSS is not only physical but also contributes to mental health problems since anxiety and depression might take in and then eventually discourage patients from returning for medical care.
Causes of FBSS
The causes of FBSS often relate to traditional open spine surgeries and spinal fusions, which have their own set of risks and limitations. Open spine surgery is a traditional method for treating spinal problems by removing parts of the vertebrae or discs to take pressure off the spinal cord and nerves. This is an extensive method with a large incision and a great deal of muscle dissection, hence highly invasive, with a long recovery period. The method is also linked to a high rate of failures and complications, which include the formation of scar tissue.
Spinal fusion procedures involve fusing two or more vertebral bodies together, often utilizing bone grafts or hardware. Ideally, this will cause pain to be reduced by providing stability to a portion of the spine that may be painful. However, though this may alleviate some symptoms, it generally reduces the mobility at the level being fused and places added stress on adjacent vertebrae. Additional stress can then lead to what is known as adjacent segment disease, a condition wherein segments of the spine adjacent to a fused area begin to degenerate or become painful.
Some of the most common causative factors for FBSS include:
Adjacent Segment Disease: Stress on the adjacent vertebral segments by a spinal fusion.
Failed Fusion: A fusion which fails to fuse the vertebrae as intended.
Bone Growth: Growth of fused bone that continues impinging on nerves.
Scar Tissue Formation: Scar tissue forming around nerves and causing pain.
Post-operative Pressure: Pressure on the spinal nerves by the surgical interventions.
Recurrent Herniation: Return of a herniated disc after surgery.
Hardware issues: instrumentation used during the surgery may break down or get migrated.
Incorrect diagnosis: Inadequate pre-operative diagnosis may lead to ineffective surgery
Facet Joint Issues: development of facet joints which can project into the spinal canal or nerves.
Technical faults: disc fragments or remaining bone fragments may slip and impact the nerves. Symptoms of FBSS
A patient with FBSS has several symptoms, most of which are not evidently related to the surgery. These include:
Anxiety or Depression: Psychiatric effects resulting from chronic pain and constant discomfort.
Chronic Lower Back Pain: Continuation of pain in the lower back after surgical treatment.
Muscle Spasms: A contraction of the muscles involuntarily, usually related to pain.
Drug Addiction: Dependence on pain medication as a result of constant discomfort.
Poor Mobility: Reduced mobility due to surgery or the pain.
New Pain Locations: Pain begins to show up in areas other than the location where the pre-surgery pain was located.
Numbness or Pain: Sensory change or pain in the back or legs.
Prolonged Recovery: Longer and more painful recuperation period.
Sleeplessness: Inability to sleep comfortably, usually associated with pain or discomfort.
Stabbing Pain: Sharp pain in arms or legs, an indication of nerve involvement.
Diagnosing FBSS
The diagnosis of FBSS is done by a professional after a proper examination. First and foremost, the doctor will conduct a physical examination by studying the restrictions of movements and muscle weakness. The physician might test for reflexes, too, and ask several questions regarding their style of life, previous treatments, and in what way they are experiencing pain.
Imaging tests, including x-rays, MRIs, or CT scans, are tremendously instrumental in forming the diagnosis of FBSS. Such scans can detect the cause of your pain and suggest a course of treatment. It may also be helpful to review previous imaging studies to understand the causes of continued discomfort.
Treatment for FBSS
The Bonati Spine Institute is renowned for its expertise in treating FBSS, especially those that are of iatrogenic origin from failed prior surgeries. This institute incorporates the latest techniques with patented instrumentation in treating conditions related to spinal hardware and failed conventional surgeries.
Surgical Treatments
- Discectomy: A surgical procedure removing the diseased portion of a disc; often, using a laser to shrink and remodel the remaining disc.
- Laminectomy/Laminotomy: This decompression surgery involves the removal or trimming of part of the lamina to take some pressure off the spinal nerves.
- Foraminotomy/Foraminectomy: The process relieves pressure on nerves at the intervertebral foramina neural foramen.
- Re-exploration of Spinal Fusion: It corrects compression of nerves caused by a failed spinal fusion through taking out the bone and scar tissue. It re-establishes spinal anatomy by way of a small incision with specialized instruments, thereby relieving compression on nerves.
Prevention and Self-Care
While FBSS cannot be completely prevented, the risk of developing this syndrome can be reduced if certain measures are adopted:
- Follow the Instructions of Surgeons: Obey all instructions prescribed by your surgeon regarding recovery and rehabilitation.
- Get Proper Physical Therapy: Attend all the physical therapy sessions prescribed for your recovery and to make your spine stronger.
- Take a Healthy Diet: A healthy, balanced diet for improving your general health will also enhance your prospects of recovery.
- Lifestyle Modifications: Quit smoking and limit alcohol intake to promote healing.
- Exercise: Continue appropriate exercises for spinal health and to avoid any complications.
If you believe you have FBSS, it is essential that you discuss your treatment options with a specialized spine center like The Bonati Spine Institute located in Tampa, FL. They conduct complete evaluations and work with advanced treatments focused on solving the intricacies of FBSS.
