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Failed back syndrome (FBS) is a sometimes-disputed name for patients with low back pain who fail to get relief from back surgery, or have worsening symptoms following the surgery. According to the American Association of Neuroscience Nurses, “Following the initial surgery, occurrence of FBS is approximately 15 percent. For patients who undergo a second spinal surgery, approximately 50 percent will report improved symptoms.”
This syndrome can lead to chronic pain, decreased function, and permanent disability in some patients. It is a frustrating issue that does not always have a clear cause or cure. FBS also takes an emotional toll on sufferers who may be accused of malingering or hypochondriasis. Severe chronic pain affects every relationship a patient is a part of and can be economically devastating.
There are many thoughts on factors that contribute to FBS. Primary factors are thought to be incorrect diagnosis or surgery that isn’t indicated for the diagnosis and perioperative technical problems. Technical problems may include errors or problems such as hematoma formation. Typically patients with radicular or leg pain have better outcomes than patients with only back pain.
It is important to have enough testing before surgery to be sure of what the pain generator is. If the cause of low back or leg pain cannot be definitively diagnosed or provoked, the odds of a successful surgery are not as great. Factors that contribute to FBS include smoking, a physically demanding job, and sometimes psychological dysfunction. Studies have also shown that pending litigation is a contributing factor.
Other possible causes of FBS may be infection, re-herniation of the problematic disc, scar tissue called epidural fibrosis, or arachnoiditis. A leak of spinal fluid due to accidental damage to the dura, which is the tissue that surrounds the spinal cord may also be an issue.
In some cases a second surgery can relieve symptoms. In other cases interventions such as physical and occupational therapy and pain therapy are used. Patients who don’t find relief may be prescribed long-term pain medications or other therapies such as nerve stimulation or implanted pain pumps. Implantable pumps are usually a sort of a last ditch effort when other modes of treatment have failed to decrease pain and dysfunction.
Spinal surgery has come a long way in the last 20 years. Most cases are successful. It is important to find a board certified spine surgeon who treats a lot of patients with your specific diagnosis, and to have realistic expectations about recovery.
Sources:
Bader MK & Littlejohns LR. (2004). AANN Core Curriculum for Neuroscience Nursing (4th Ed.). St. Louis, Saunders.
BMJ 2003;327:985-986 (25 October), doi:10.1136/bmj.327.7421.985.
http://www.bmj.com/cgi/content/full/327/7421/985
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