Failed Back Surgery Syndrome or Persistent Spinal Pain Syndrome?
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Persistent Spinal Pain Syndrome Overview
A patient may fail to improve even after the best surgical intervention. Despite careful diagnosis and a successful operation, some patients may continue to have persistent pain or experience limitations in the performance of their daily activities.
The medical term for this condition was once Failed Back Surgery Syndrome, more recently known as “Persistent Spinal Pain Syndrome” (PSPS). Symptoms include chronic back or neck pain, with or without extremity pain, which can occur if a spine surgery does not achieve the desired result.
Many medical authorities, including the National Institute of Health, consider the term “failed back surgery syndrome” to be an inaccurate term for both surgeons and patients alike as it represents a mismatch between preoperative expectations and the outcomes of surgery. The main criticism is that this term is not only misleading but also potentially hurtful for practitioners as its initial connotation suggests failure or blame.
Table of Contents
Symptoms
Diagnosing
Treatments
A Spine Surgeon Explains Failed Back Syndrome
While the medical condition known as “failed back surgery syndrome” is a legitimate orthopedic diagnosis that results in chronic pain for the patient experiencing it, the condition is somewhat confusing.
“Spine surgery is possibly the only field of medicine that has the dubious distinction of having a diagnosis called ‘failed surgery’ associated with it,” said Dr. Ted Belanger, a spine surgeon at Texas Back Institute. “For example, there is no such diagnosis as ‘failed heart surgery syndrome.’ Failed back surgery syndrome is not one disease process or one problem. There are many considerations.”
This condition has been the impetus for considerable research and even a new definition. According to an article from Dr. Simon Thompson, which was published by the National Institutes of Health, “Failed back surgery syndrome is an unhelpful term that hides the true issues concerning the mechanism of pain and subsequent therapies that patients with chronic radicular neuropathic pain are exposed to.”
He offered a more concise definition for this condition:
Persistent or recurrent pain in the back/neck or limbs despite surgery or treatment thought likely to relieve pain. A more accurate name for this condition is Persistent Spinal Pain Syndrome.
The Causes of Persistent Spinal Pain Syndrome
Dr. Belanger explained some of the causes for this diagnosis.
“There are a whole host of potential reasons that someone who has had surgery on their spine could experience what is perceived as a ‘failure,’” he said. “The most common reasons are normal complications associated with surgery, the possibility of an incomplete surgery or an overly aggressive surgery. There are also patient factors, such as coexisting medical conditions, which contribute to this condition. It is really a ‘basket’ of problems that are all mixed together.
“The most common reason a patient is labeled as having failed back surgery is an inadequate decompression. With this condition, the patient has typically had nerve impingement as the original reason for the surgery. Because of this, they have pain and numbness down their legs or arms.
“To try to alleviate the nerve pain, the surgeon executes the procedure with the correct intentions, directed at the right problem, but simply does not make enough room for the nerve in one place or another. This results in the patient having similar symptoms as they had before, and we would term this a ‘failure.’”
Patients Ask:
Should All Back Surgery Be Avoided?
Texas Back Institute Responds: For most spinal conditions, like herniated discs or sciatica, conservative care treatment, including medications and physical therapy, is the first treatment option. If physical therapy and injections do not work, patients may need additional treatment. At Texas Back Institute, surgery is always a last resort. At each step along the way, we reevaluate the patient and the effects of the spine pain on function and lifestyle. Once the patient gets to an acceptable level of pain and function, we slow down and hopefully the patient continues to get better.
What Are the Symptoms for Persistent Spinal Pain Syndrome?
After any spine surgery, a percentage of patients report that they are still experiencing pain. Common symptoms include diffuse, dull, and aching pain in the back and/or legs. Patients may also complain of sharp, pricking, burning, or stabbing pain in the extremities.
- Failed Cervical Fusion: These symptoms are the result of a failure of the bones to fuse or from the rejection of a bone graft by the body (a foreign piece of living tissue that is surgically transplanted). Symptoms may include back or neck pain, stiffness, weakness, numbness, tingling and a burning sensation in the arms and legs, or difficulty with walking or hand coordination.
- Post Laminectomy Syndrome: PLS affects a small percentage of people who undergo a laminectomy. Symptoms may include lingering pain that can manifest as dull and achy or a sharp, prickling or stabbing pain, often like the pain they felt prior to surgery.
- Pseudoarthrosis, or Failed Fusion Syndrome: Symptoms may include persistent back pain, limited mobility, back spasms, insomnia due to discomfort, and numbness, tingling, and weakness in the extremities.
Patients Ask:
What Are Some Risk Factors for Persistent Spinal Pain Syndrome?
Texas Back Institute Responds: Some of the causes and risk factors associated with PSPS include smoking, formation of scar tissue, recurring or persistent disk disease at adjacent levels, continued pressure from spinal stenosis, spinal instability, pseudoarthrosis (failed fusion), or nerve damage within the nerve.
Remarkable Medical Technology
The spine surgeons at TBI use state-of-the-art technology, such as robotics, intraoperative CT scans, and computer-assisted navigation, in minimally invasive surgery.
“These technologies are used in myriad ways,” Dr. Belanger said. “We stay current on cutting edge technology and techniques, in addition, we use other tools that may be available to us to do the right surgery for each patient.
“Some of us use computer-assisted surgery to navigate the placement of instrumentation, such as screws and rods, which might be needed to stabilize the spine. In the case of a disc fusion procedure, we often use an image guidance system to assist in the accuracy of the disc placement during that surgery.
“A few of my partners at Texas Back Institute are inventors and pioneers in the use of robotics in spine surgery. They are global leaders in this way of performing surgery.
“I believe the existence of robotic options or other navigation tools in the placement of instrumentation allows us to perform even less invasive techniques. This has been a very exciting development over the last decade or so.”
What is the Treatment for Persistent Spinal Pain Syndrome?
Treatment for PSPS may include physical therapy, nerve blocks, medications, injections, or a chronic pain management program. If the pain is possibly coming from the facet or sacroiliac joints, chiropractic care may be recommended.
Correctable structural problems are sought and, if identified, additional surgery may be recommended to address these issues with PSPS. This may include facet joint or sacroiliac joint rhizotomy, spinal fusion, or sacroiliac joint fusion.
In some cases, no correctable cause of the patient’s symptoms is identified. In these cases, spinal cord stimulation (SCS) or narcotic pumps may be used for pain control.
Your physician will recommend several non-medical pain management approaches in addition to the above, such as walking as tolerated, using cold packs to reduce inflammation, and sitting and sleeping in a supported position that reduces stress on the surgical site.
If the post-surgical pain, weakness, and/or numbness don’t improve with the above treatments, or become worse, revision surgery may be considered.
Signs of Failed Back Surgery Syndrome
What should a patient be conscious of if he or she is worried about failed back surgery?
“The answer to this lies in the definition presented earlier as to what constitutes failed back surgery syndrome,” Dr. Belanger said. “When a patient enters into a surgical procedure for whatever injury or disease process they are experiencing, there will be an expectation of certain outcomes. If the surgery fails to achieve that, we will consider a failed back surgery diagnosis.
“This does not always mean the patient requires more surgery or something was done incorrectly or inappropriately. Sometimes the expectations of the surgeon or the patient are unrealistic and therefore could never be met.
“On average, if the purpose of a surgery were to alleviate nerve pain in the patient’s legs or arms and this pain is still there after the procedure, that is pretty much what failed back surgery syndrome looks like. Further investigation can often lead to other successful treatments for a condition such as this.
“Every situation is unique, and every surgeon’s objective is to help the patient relieve their pain.”
What is the Treatment for Persistent Spinal Pain Syndrome?
Treatment for PSPS may include physical therapy, nerve blocks, medications, injections, or a chronic pain management program. If the pain is possibly coming from the facet or sacroiliac joints, chiropractic care may be recommended.
Correctable structural problems are sought and, if identified, additional surgery may be recommended to address these issues with PSPS. This may include facet joint or sacroiliac joint rhizotomy, spinal fusion, or sacroiliac joint fusion.
In some cases, no correctable cause of the patient’s symptoms is identified. In these cases, spinal cord stimulation (SCS) or narcotic pumps may be used for pain control.
Your physician will recommend several non-medical pain management approaches in addition to the above, such as walking as tolerated, using cold packs to reduce inflammation, and sitting and sleeping in a supported position that reduces stress on the surgical site.
If the post-surgical pain, weakness, and/or numbness do not improve with the above treatments, or become worse, revision surgery may be considered.
Reduce the Pain
Whatever the medical term might be, FBSS or Persistent Spinal Pain Syndrome, the spine experts at Texas Back Institute offer relief from this pain. If you’re experiencing pain, click here and get your life back.
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Frequently Asked Questions
For most spinal conditions, like herniated discs or sciatica, conservative care treatment, including medications and physical therapy, is the first treatment option. If physical therapy and injections do not work, patients may need additional treatment. At Texas Back Institute, surgery is always a last resort. At each step along the way, we reevaluate the patient and the effects of the spine pain on function and lifestyle. Once the patient gets to an acceptable level of pain and function, we slow down and hopefully the patient continues to get better.
Some of the causes and risk factors associated with PSPS include smoking, formation of scar tissue, recurring or persistent disk disease at adjacent levels, continued pressure from spinal stenosis, spinal instability, pseudoarthrosis (failed fusion), or nerve damage within the nerve.
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