Failed Back Syndrome

Failed Back Syndrome
Failed Back Syndrome (FBS) or Post-laminectomy Syndrome is a condition characterized by persistent pain following back surgeries.

Failed back syndrome (FBS), more commonly referred to as "failed back surgery syndrome" (FBSS), refers to chronic back and/or leg pain that occurs after back (spinal) surgery. Multiple things can contribute to FBS. These include residual or recurrent disc herniation, continued post-operative pressure on a spinal nerve, joint hypermobility with instability, scar tissue (fibrosis), depression, anxiety, sleeplessness and loss of spinal muscle tone. Patients may be more at risk for the problem because of diabetes, autoimmune disease and peripheral blood vessels (vascular) disease. Smoking is a risk for poor recovery from such an operation.

Causes of the Failed Back Syndrome
Surgeons will argue that the cause of FBSS "can be poor patient selection, incorrect diagnosis, suboptimal selection of surgery, poor technique ...and/or recurrent pathology", as well as including "failure to achieve surgical goals". Unfortunately the causes of continued pain are difficult to identify and pain can become chronic. Repeated surgical intervention is not usually helpful. For those contemplating more surgery additional complications must be considered. Complications of spinal fusion surgery may include instrument failure, bone-donor site infection or chronic pain; neural injuries, pulmonary embolus, infections, vascular complications (rare but potentially very serious) and failure to achieve a solid fusion.

Symptoms of Failed Back Syndrome
Common symptoms associated with FBS include generalized, dull and aching pain involving the back and/or legs. Abnormal sensations may include sharp, pricking, and stabbing pain in the legs. The term “post-laminectomy syndrome” is used by some doctors to indicate the same condition as failed back syndrome.

Treatment of Failed Back Syndrome
The goal of the treatment for FBS is based on helping the patient control the symptoms and improve their quality of life. Gradually increasing exercise and changing the lifestyle to avoid things that increase the pain are very important. Treatment can include medications for pain and inflammation. Medications to change the way pain signals are sent in the body, such as gabapentin (Neurontin), pregabilin (Lyrica) and amitriptyline (Elavil) may improve the pain. Medications for depression may also be helpful. Interventional (injection) treatments to treat some of the sources of pain include diagnostic blocks to evaluate the pain sources. Pain coming from the facet joints may improve with radiofrequency rhizotomy. Epidural steroid injections may also help improve pain, particularly if it goes into the legs.

In addition, more invasive modalities, such as spinal cord stimulation, may offer relief for certain patients with FBSS, but these modalities, although often referred to as “minimally invasive", require additional surgery, and have complications of their own.

Adapted from Wikipedia

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