Failed Back Surgery Syndrome

The post below was featured on Spine-Health.com and was contributed by Dr. Stephen Hochschuler, co-founder and orthopedic spine surgeon at Texas Back Institute.

Failed Back Surgery Syndrome (FBSS) refers to chronic back or neck pain, with or without extremity pain, which occurs if spine surgery does not achieve the desired result. Contributing factors include recurrent disc herniation, compressed nerves, altered joint mobility, scar tissue, muscle deconditioning and degeneration of facet or sacroiliac joints.

The problem of failed spine surgery has long been a perplexing and intriguing problem my colleagues and I have tried to accurately analyze and pro-actively prevent. My goal as a spine surgeon is to help treat patients with pain stemming from their spine. Many times I am able to treat patients with nonsurgical treatment options, such as physical therapy or medication, and they do very well. In some instances though, this treatment plan does not provide patients with the pain relief needed so we have to pursue more aggressive treatment options including surgery.

I always consider surgery to be a last option approach to spine care and therefore am very careful to make sure my patients are in the best position to have a successful surgery, in turn minimizing the chances of FBSS. Through experience I know there are several factors that have shown to contribute to failed back surgery syndrome, and therefore I follow the protocol below to make sure my patients are set up for their best outcomes:

  1. Before the surgery:
    • Always treat patients conservatively (non-operatively) first
    • Make sure the patient is correctly diagnosed – meaning that the cause of the patient’s pain has been accurately identified
    • Provide a thorough pre-operative evaluation
    • Make sure the surgery is the right one for the patient
    • Appropriately educate and set expectations for the patient, including pre-operative psychological evaluations.
  2. During the surgery:
    • Take all proper precautions to minimize intra-operative issues.
  3. After the surgery:
    • Keep a close eye on post-operative recovery
    • Work closely with the patients’ interdisciplinary care team.

If you are considering spine surgery, it is important to sit down with your surgeon and determine how he actively attempts to minimize the risk for failed back surgery syndrome. If you have been diagnosed with FBSS, it is not necessarily the end of the road. There exist many alternative treatment approaches to deal with this syndrome, but once again one size does not fit all. It is important to find a surgeon who has experience in treating patients with FBSS and can offer you multiple treatment options.

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