Failed back surgery syndrome: What it is and how to avoid it

Failed back surgery introduction

Failed back surgery syndrome (also called FBSS, or failed back syndrome) is a misnomer, as it is not actually a syndrome - it is a very generalized term that is often used to describe the condition of patients who have not had a successful result with back surgery or spine surgery. There is no equivalent term for this in any other type of surgery (e.g. there is no failed cardiac surgery syndrome, failed knee surgery syndrome, etc).

There are many reasons that a surgery may or may not work, and even with the best surgeon and for the best indications, spine surgery is no more than 95% predictive of a successful result.

Spine surgery is only basically able to accomplish two things:

1. Decompressing a nerve root that is pinched, or

2. Stabilizing a painful joint

Unfortunately, back surgery or spine surgery cannot literally cut out a patient’s pain. It is only able to change anatomy, and an anatomical lesion (injury) that is a probable cause of back pain must be identified prior to back surgery or spine surgery.

By far the number one reason back surgery is not effective is because the lesion that was operated on is not in fact the cause of the patient’s pain.

Some types of back surgery are far more predictable in terms of alleviating a patient’s symptoms than others. For instance,

• A discectomy (or microdiscectomy) for a lumbar disc herniation that is causing leg pain is a very predictable operation. However, a discectomy for a lumbar disc herniation that is causing lower back pain is far less likely to be successful.

• A spine fusion for spinal instability (e.g. spondylolisthesis) is a relatively predictable operation. However, a spine fusion for multi-level lumbar degenerative disc disease is far less likely to be successful in reducing a patient’s pain.

Therefore, the best way to avoid a spine surgery that leads to an unsuccessful result is to stick to operations that have a high degree of success and to make sure that an anatomic lesion that is amenable to surgical correction is identified preoperatively.

In addition to the above-mentioned cause of failed back surgery syndrome, there are several other potential causes of a failed surgery, or continued pain after surgery:

• Fusion surgery considerations (such as failure to fuse and/or implant failure, or a transfer lesion to another level after a spine fusion, when the next level degenerates and becomes a pain generator)

• Lumbar decompression back surgery considerations (such as recurrent stenosis or disc herniation, inadequate decompression of a nerve root, preoperative nerve damage that does not heal after a decompressive surgery, or nerve damage that occurs during the surgery)

• Scar tissue considerations

• Postoperative rehabilitation (continued pain from a secondary pain generator)

By: Peter F. Ullrich, Jr., MD
January 28, 2003 (Updated June 1, 2004)