Failed Neck and Back Surgery Syndrome

What is Failed Neck and Back Surgery Syndrome?

Failed back surgery or FBSS is a condition of lumbar spinal pain of unknown origin either persisting despite the surgical intervention or appearing after surgical intervention for spinal pain originally in the same topographical location. The above definition was established by the International Association for the study of pain.

Despite our understanding that this condition exists, quality studies are lacking. Part of the problem is that repeating spinal surgery can often have diminishing returns. Although more than half of the primary surgeries are successful, a second surgery and subsequent surgeries have decreased success. Treatment options start with physical therapy and a full multidisciplinary approach. Diagnostic injections identifying as closely as possible the etiology, should be immediately commenced. Differentiation should be made between the main spinal bones versus the nerve structures.

Imaging studies begin with plain radiographs and x-rays to determine if there are any fixable hardware issues, loose screws, broken plates, etc. Following this, further imaging with MRIs and CAT scans with or without gadolinium contrast enhancement, electrodiagnostic studies, and dynamic flexion-extension images should be conducted. Further treatment options include the full gamut of pain procedures including epidural steroid injections, usually either by the caudal, transforaminal, or the caudal Racz catheter procedure. Furthermore invasive procedures include Spinal Cord Stimulation – the most common and the most effective procedure in treatment of FBSS. Medication management includes the full gamut of pain medication, including antiepileptics, antidepressants, topical ointments and creams, and opioid medication. Opioid medication, whether delivered by mouth or with a catheter directly into the spinal fluid, can be useful as a last-resort procedures.