FAQ’s on Failed Back Surgery Treatment in Las Vegas

Failed Back Surgery Syndrome

Failed back surgery syndrome (FBSS) occurs when pain continues after spinal surgery. This condition is characterized by chronic pain that fails to respond to surgery and many treatments.

Is failed back surgery syndrome a common condition?

Around 600,000 people have back surgery every year. FBSS affects around 40% of people who have back surgery.

What causes failed back surgery syndrome?

The purpose of spinal surgery is to stabilize painful back joints, decompress nerves, and relieve pain. Back surgery does not work for every person, and complications can occur that result in worsening of back pain. The causes of back and/or leg pain associated with FBSS are:

  • Fracture
  • Scarring (fibrosis)
  • Recurrent disc herniation
  • Adjacent segment syndrome
  • Muscle atrophy
  • Altered joint mobility
  • Spinal instability
  • Muscle atrophy
  • Spinal fusion failure
  • Failure to remove herniation or lesion

Who is at risk for failed back surgery syndrome?

Some people are more at risk for failed back surgery syndrome than others. Those at risk are people with:

  • Diabetes mellitus
  • Peripheral vascular disease
  • Rheumatoid arthritis
  • Multiple sclerosis
  • Lupus erythematosus

What symptoms are associated with FBSS?

Patients who have failed back surgery syndrome often have severe, chronic back pain. When nerve irritation and/or compression occurs, the patient may experience leg symptoms, such as numbness, weakness, tingling, and/or pain.

How does the doctor diagnose failed back surgery syndrome?

Some pain following back surgery is expected. However, when pain worsens or persists following surgery, the doctor will conduct diagnostic testing to assess for spinal instability, scarring, and structural problems. Tests ordered include x-rays, magnetic resonance imaging (MRI) scans, and computed tomography (CT) scans. When nerve symptoms occur, the doctor will perform a nerve conduction study.

How is FBSS treated?

The treatment of failed back surgery syndrome depends on the severity of the condition, the cause of the pain, and the health of the patient. Pain management specialists often use a combination of therapies to relieve symptoms. Options include:

  • Medication – For nerve-related pain, the doctor will prescribe Neurontin or Lyrica. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for mild pain associated with inflammation. For severe, intense pain, opioid analgesics are prescribed, such as hydrocodone and oxycodone.

 

  • Physical therapy – The physical therapist will design a rehabilitation program tailored to meet the individual patient’s needs. Stretching and strengthening maneuvers are used to improve muscle strength, flexibility, and motion. For pain relief, the therapist uses massage, electrical stimulation, and ultrasound therapy.

 

  • Facet joint injection (FJI) – When spinal arthritis is associated with FBSS, and if nerves are involved, an FJI can help. The doctor inserts small needles into the tiny facet joints along the posterior region of the spine. A long-acting anesthetic, with or without a corticosteroid, is instilled near the nerves. A recent clinical study found that FJIs offered significant pain relief.

 

  • Epidural steroid injection (ESI) – Between the spinal cord and the epidural layer is the epidural space. With the ESI procedure, the doctor injects a corticosteroid into this space to alleviate inflammation of nerves. This procedure has an 80-90% efficacy rate.

 

  • Spinal cord stimulation (SCS) – For patients who do not do well on other treatments, the doctor can surgically implant a spinal cord stimulator. This device is placed in the lower abdomen or buttocks. Wires run from the device to electrodes, which are placed near the spinal cord. The device delivers pleasant electrical sensations to the spine to interfere with pain signal transmission. According to a recent clinical study, SCS was effective for long-term pain relief associated with FBSS.

Resources

De Ridder D, Plazier M, Menovsky T, Kamerling N, & Vanneste S (2013). Subcutaneous stimulation for failed back surgery syndrome: A case report. Neuromodulation.

Falco, FJ, Manchikanti, L, Datta, S, et al. (2012). An update of the effectiveness of therapeutic lumbar facet joint interventions. Pain Physician, 15(6), 909-953.

Jacques L, Jensen T, Rollins J, Burton B, Hakim R, & Miller S (2012). Decision memo for transcutaneous electrical nerve stimulation for chronic low back pain (CAG-00429N). tinyurl.com/ decisionmemoTENS