What is failed back surgery syndrome?

It is a condition characterised by persistent pain that may or may not include leg, and or back pain following back surgeries.

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According to Hubert L. Rosomoff, MD, a neruosurgeon in Miami Flordia, "Just about any approach is better than having surgery because all the studies have shown that, if you take a surgical population and nonsurgical population, they all seem do the same in five years," he said. "So if you can avoid surgery and the expense of surgery, obviously, you might do as well as the [patient] that gets [the surgery]." http://www.docguide.com/news/content.nsf/news/58724C06DE466C1F852569F9004A13A1?OpenDocument&id=29DA64443C49B34E852568CB00031B46&c=Back%20Pain&count=10

Following open spine surgery, whether it is a fusion, discectomy or laminectomy patients can experience chronic pain in the back and or the arms or legs. These syndromes are often due to identifiable causes but are termed by surgeons and the medical community to be failed back surgery syndrome (FBSS). Nearly all open back surgeries include one form of fusion. The true test of whether an open back surgery is successful is not to measure the success of the fusion process but the actual reduction of pain. Although most published articles describe an 80% good/excellent result rate, personal experience by most physicians in the field suggests that the true proportion of good to excellent results is closer to 50% for single level fusions, while with three levels, this drops to approximately 15%.

The most common causes of FBSS do not involve technical errors on the part of the surgeon, but are due to the inherent risks of the body's reaction to an invasive procedure. Some of the most common causes include:

  • Epidural fibrosis, or scarring of the nerve roots, is a common cause of FBSS and it involves no technical errors on the part of the surgeon. It is simply an unfortunate response of the body to the trauma of surgery.
  • Other identifiable causes of the FBSS include inadequate decompression which results in untreated lateral recess and foraminal stenosis.
  • Residual foraminal stenosis.
  • Residual spinal stenosis.
  • Painful disc disease due to residual pain emanating from the discs which still retain motion.
  • Spinal instability due to removal of too much of the central disc or supporting ligaments.