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Failed Back Surgery Syndrome: Its Causes and Treatment

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.

What Causes Failed Back Surgery 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 that 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 a 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.'”


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A Minimally Invasive Approach to Correcting This Condition

The spine surgeons at Texas Back Institute use a minimally invasive approach to surgery for this condition. Why?

“Each patient situation is unique,” Dr. Belanger said. “And there will be times when there will be limited options for revising the procedure and a traditional, open surgery is all that is available. This sometimes involves a more invasive procedure.

“However, there may be times when there are several strategies we could use, and we frequently choose the least-invasive approach available to us. Our expectation and judgment that the procedure will effectively solve the problem are our primary criteria for choosing a given approach.”

 Remarkable Medical Technology

The spine surgeons at TBI use state-of-the-art technology, such as robotics, interoperative 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 in order 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 actually 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.”

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 would 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 was to alleviate nerve pain in the patient’s legs or arms and this pain is still there after the procedure, that’s 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.”


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