What is failed back syndrome?
When a patient continues to experience severe back and/or leg pain after spine surgery it is referred to as failed back syndrome. Therefore, failed back syndrome is not a cause of pain in and of itself, it’s a term used to describe persistent symptoms after surgery.
What are the symptoms of a failed back syndrome?
A patient with failed back syndrome will, by definition, have very similar symptoms after as before surgery. This may be back pain, sciatica or symptoms of spinal stenosis.
What causes failed back syndrome?
There may be a number of reasons why patients are left in pain after prior surgery. Some patients may have had the right procedure, only to see it fail; spine surgery has a well described failure rate. In other patients, it may be that there spinal condition has progressed to involve an area of the spine not previously operated on. In yet others, it may be that pain is being caused by an area not addressed by surgery. Though the cause may be progression of disease or an area not addressed by surgery, patients and physicians alike may wrongly label the patient as having had “failed back” surgery.
How is failed back syndrome evaluated?
The first step in the evaluation of persistent pain after surgery is a careful history and physical examination. Often, a history will give many clues as to whether or not the pain is coming from a condition addressed at surgery, or is a new condition. Often, repeating x-rays and MRI’s is useful in determining whether the condition is a progression or new condition, as opposed to a persistent one. Failed back syndrome is a frustrating condition to patients and doctors alike, and great patience on the part of both are required.
How is failed back syndrome treated?
In patients who have pain after surgery a spinal pain management evaluation can be performed. In this highly specialized evaluation, we try to determine if the pain is persistent after surgery, is transient post-surgical pain, is due to a progressive condition or is new. In many cases, spinal injections or minimally invasive surgery can bring relief if used appropriately and targeted precisely to the cause of pain. As a last resort, spinal cord stimulators have a track record of providing relief in carefully selected patients.
Failed back treatments
The following spinal injections can be used to treat failed back syndrome:
The following minimally invasive surgical procedures can be used to treat failed back syndrome:
