Failed back surgery syndrome (also called FBSS, or failed back syndrome) or post-laminectomy syndrome is a misnomer. The general definition is persistent or recurrent symptoms in someone who had previous spine surgery. They might feel better for a little while and then start to get worse or perhaps they got worse than before the surgery.
Sometimes, the underlying cause for the back pain simply progresses after surgery due to the disease process itself or a failed fusion.
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 and have experienced continued pain after surgery. There are many reasons that a back 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 basically able to accomplish only two things:
- Decompress a nerve root that is pinched, or
- Stabilize a painful joint.
Causes and Risk Factors or Reasons for Failed Back Surgery
- Smoking
- Formation of scar tissue
- Recurring or persistent disc disease at adjacent levels
- Continued pressure from spinal stenosis
- Instability or abnormal movement
- Pseudoarthrosis or failure of the fusion
- Nerve damage within the nerve, arachnoiditis
Unfortunately, back surgery or spine surgery cannot always stop the source of pain by cutting it out. This could be due to the type of damage already present as in scar tissue. 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 rather than after back surgery or spine surgery.
The number one reason back surgeries are not effective and some patients experience continued pain after surgery is because the incorrect diagnosis was made and the lesion that was operated on was the cause of the patient’s pain.
Predictability of Pain after Surgery
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 has a very predictable outcome. 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 straight-forward operation. However, a fusion surgery for multi-level lumbar degenerative disc disease is far less likely to be successful in reducing a patient’s pain after surgery.