Failed Back Surgery Syndrome (FBSS)

Jul 28, 2016

Occasionally, spine surgery doesn’t provide the relief patients expect. In fact, 20 to 50 percent of the patients that visit Dr. Jatana’s practice have had previous back surgery with another surgeon and are seeking a second opinion on how to resolve continuing pain. The good news is that in many cases, the cause of the pain can be identified and addressed.

In this Q and A, Dr. Jatana discusses this condition, formally known as Failed Back Surgery Syndrome.

Q. How can patients avoid Failed Back Surgery Syndrome?

A. The best way for patients to ensure a good result when confronting spine issues is to consider a non-surgical approach first and to seek alternative treatment options if they don’t believe the source of their pain has been accurately diagnosed. If surgery is recommended, stick to operations that have a high degree of success, such as decompression surgery to fix a pinched nerve. It’s also wise to ensure that you’re a good candidate for the surgery that’s being recommended. For example, degeneration is most likely after a two-level fusion in younger patients, so an artificial disc replacement (which should lessen the risk of degeneration in adjacent discs) might be a better option than fusion surgery.

Q: What types of issues might cause a patient to experience persistent pain after surgery?

A: The reasons for post-surgery pain will vary depending on the patient and the type of surgery
performed. For example, with fusion surgery, common problems include broken hardware and the failure to achieve a solid fusion. In some cases, the level above or below the fusion can degenerate, causing additional pain. Pre-existing nerve damage and scar tissue that develops after surgery can also produce pain after a variety of spine surgeries. Finally, sometimes the cause of a patient’s pain is misidentified, leading to surgery on the wrong site.

Q. What’s the process you employ to help patients who have persistent pain after spine surgery?

A. The first step is to talk with the patient and address the original goal of surgery. Then, we get X-rays or an MRI to check the hardware, determine if the fusion is solid (in the case of fusion surgery) and assess whether an adjacent level has broken down. When those three areas look good, we then consider other problems, such as nerve damage. We can perform an electromyogram to determine the cause of that damage.

Q. What can be done to resolve pain for patient’s post-surgery?

A. A non-fusion can be addressed through repeat surgery with stronger implants and bone products to help achieve a solid fusion. If broken hardware is the culprit, sometimes just removing the broken hardware can relieve the pain. Fixing the adjacent level above or below a fusion through surgery is also an option. When diagnostic studies can’t find the problem and surgery is not an option, then spinal cord stimulation technologies, which have had success in selected patients, might be considered.