Spine is itself a very complex structure. Many times it is very difficult to arrive at diagnosis. Some times more than cause lead to back pain. In back surgery, doctors work with the aim of reducing a patient’s pain by changing the spine's anatomy, especially at the lesion site.
Back Surgery Syndrome or Failed Back Syndrome means the patient’s back failed to get better after surgery. It is not clear whether the terminology was formulated to identify a new category of disease entity (including spinal surgery) or to avoid having to specifically mention some of the diagnoses that may reveal the failure of the treatment given.
This term casts stigma that assumes that there is nothing else positive that can be done to help them. So now the term post laminectomy syndrome is used to describe persistent pain after spine surgery. The diagnosis of post laminectomy syndrome is given when there is persistent or recurrent neck or neck and arm pain following neck surgery, or back or back and leg pain following low back surgery.
Post laminectomy syndrome is most common after fusion or laminectomy but can occur following discectomy as well. The incidence of FBSS ranges between 5 and 50 %, which is mainly attributed to the rise in number of surgeries performed.
Failed back surgery syndrome can be due to a number of factors that doctors and researchers are still discussing. These include:
Most patients with FBSS have accompanying psychological, social and/or vocational problems indirectly related to the pain. It’s important that these issues be carefully sorted out before any decision to go back for more surgery is made, as they can cloud the evaluation of next steps to be taken.
A complete, detailed history, including diagnostic tests, adverse events and attempted therapeutic modalities, needs to be listed and described chronologically.
Treatment options for FBSS are dependent upon:
Most patients with FBSS have accompanying psychological, social and/or vocational problems indirectly related to the pain. It’s important that these issues be carefully sorted out before any decision to go back for more surgery is made, as they can cloud the evaluation of next steps to be taken.
A complete, detailed history, including diagnostic tests, adverse events and attempted therapeutic modalities, needs to be listed and described chronologically.
Treatment options for FBSS are dependent upon:
Initially start with pharmacological treatment along with physical & psychological measures.
Interventional treatment includes
Failed back syndrome or post-laminectomy syndrome is a condition characterized by persistent pain following back surgeries. Failed back syndrome (FBS), also called "failed back surgery syndrome" (FBSS), refers to chronic back and/or leg pain that occurs after back (spinal) surgery.
It is characterized as a chronic pain syndrome.
An individual may be predisposed to the development of FBS due to systemic disorders such as diabetes, autoimmune disease and peripheral blood vessels (vascular) disease. Smoking is a risk for poor recovery.
associated with FBS include diffuse, dull and aching pain involving the back and/or legs. Abnormal sensibility may include sharp, pricking, and stabbing pain in the extremities
physical therapy, minor nerve blocks, transcutaneous electrical nerve stimulation (TENS), behavioral medicine, non-steroidal anti-inflammatory (NSAID) medications, membrane stabilizers, antidepressants, spinal cord stimulation, and intrathecal morphine pump. Use of epidural steroid injections may be minimally helpful in some cases. The targeted anatomic use of a potent anti-inflammatory anti-TNF therapeutics is being investigated
spinal cord stimulation