Failed Back Surgery Syndrome (FBSS)
Failed back surgery syndrome (FBSS), also referred to by doctors as “post-laminectomy syndrome”, is a term used to describe patients who continue to experience pain after spine surgery. Traditional open back surgery by nature is unpredictable at best, and most sources claim that FBSS is seen in nearly up to 60% of individuals that have previously undergone this type of surgery. Failed back surgery happens so frequently it’s currently defined as a “syndrome.”
The human spine is made up of 33 bones, also known as vertebrae. There are three main curves, the cervical, thoracic, and lumbar curve. At the bottom of the spine are the sacral and coccyx, also known as the tailbone.
Between each vertebra is an intervertebral disc. The discs work like a cushion between the bones and absorb shocks, like jumping or running. The intervertebral discs are made up of two parts, the annulus and nucleus.
Each section of the vertebral column is at risk of injury, degeneration, and spinal conditions that can lead to neck and back pain. When you undergo back surgery, specifically traditional open back surgery and/or spinal fusions, there is a risk that the issue may not be corrected or that other spinal conditions may develop and cause new or additional pain.
What is Failed Back Surgery Syndrome (FBSS)
FBSS is a generalized term used to describe the condition of a patient whose initial spinal surgery was unsuccessful. As a result of the unsuccessful spine surgery, a patient may still be dealing with the same pain as before or the surgery has led to more significant problems and worsening pain.
Not only does FBSS affect a person’s physical well-being, it can also be a trigger for mental health issues and prevent the patient from seeking out further medical attention that could help.
A large proportion of patients seen at The Bonati Spine Institute are those that have had surgery performed at another medical facility, and their back or neck pain continues because the prior surgery performed elsewhere has “failed.”
What Causes FBSS
Old-fashioned open spine surgery is the traditional surgical approach to treating spine problems. There are many disadvantages and risks associated with this type of procedure. In this highly invasive approach, a surgeon creates space by removing the part of the vertebra and/or part of the disc. This procedure enlarges the spinal canal and relieves pressure on the spinal cord and the nerves through a large incision. Traditional open spine surgery has a long recuperation time due to extensive dissection of muscles and tissues to access the area and has a high failure rate. In this approach, formation of scar tissue is very likely.
Spinal fusion surgeries use bone grafts and/or hardware to permanently “lock” together two or more vertebrae for the purpose of making a section of the spine thought to be producing pain symptoms immobile. After a fusion surgery, the patient will likely lose the mobility in his spine at the fused level. This puts further pressure on neighboring vertebrae, which may lead to adjacent segment disease.
Traditional open back surgery and spinal fusions are done under general anesthesia and often require extensive dissection of muscle tissue, several days of hospitalization, and an often painful and lengthy recovery. There is a high infection rate associated with these types of surgery. FBSS is common in traditional open back surgery and spinal fusions with about 60% of patients experiencing failed back surgery symptoms.
The Bonati Spine Institute strongly recommends against traditional open spine surgery and spinal fusions and implants, since these procedures often result in high failure rates.
While there are many triggers for FBSS, some of the most common causes of failed back surgery are:
- Adjacent segment disease
- A spine fusion that failed to connect the intended areas
- A fused bone that continues to grow and impinges on nerves
- Scar tissue formation that impinges on nerves
- Post-operative pressure on a spinal nerve
- Recurrent spinal disc herniation after surgery
- Anterior grafts and cages migrating
- Improper preoperative diagnoses of patient before surgery
- Facet joints growing and encroaching on the spinal canal or the nerves post-operatively
- Technical errors that result in a fragment of disc material missed or a piece of bone left adjacent to the nerve
- Pain due to spinal hardware that was implanted during the surgery, or hardware that breaks or becomes loose following surgery
- Residual foraminal stenosis due to inadequate exploration of the nerve root during open back surgery
Symptoms of FBSS
Patients can experience a wide array of failed back surgery syndrome symptoms that they may not relate to surgery. Some of these symptoms include:
- Anxiety or depression
- Lower back pain
- Muscle spasms
- Drug dependence
- Limited movement
- New pain at a different location than pre‐surgery pain
- Numbness or pain in the back or legs
- Prolonged, painful recuperation
- Stabbing pain in the arms or legs
Following back surgery, there may be some pain and discomfort. Depending on the surgery (for example in case of spinal fusions), the healing process may also cause discomfort due to the physical therapy requirements. While some pain can be expected, more intense or chronic pain could be a sign of something more serious.
If you’re experiencing any of the symptoms of FBSS, you should know that the pain is not normal. Your physician should be alerted to your symptoms. The healing process is different for everyone, so you should not assume your surgery failed. Only a medical professional can correctly diagnose FBSS.
Beginning with a physical examination, a doctor will look for restricted movement in the neck or spine and weakness in the arms or legs. Your reflexes may also be tested. During the physical examination, the doctor will also ask questions about your lifestyle, what treatments and rehabilitation you have undergone, the location of your pain, and whether the pain worsens with certain movements.
Exams & Tests
Your physician will review any previous x-rays, MRI or CT scans, and could request that another round of imaging tests are completed. The scans can help identify the source of your pain, provide a diagnosis and help to determine the best course of treatment.
Treatment for FBSS
The Bonati Spine Institute is world-renowned in its ability to treat previously failed back surgery performed at other facilities, including the removal of hardware inserted in spinal fusions.
Patients with an unspecific diagnosis of “back pain” who, after having had one or more operations and interventions in the spine, yet are still in pain, may be at the point where they are told that no further operation is feasible and that the surgeon has “done everything he or she can.” This is where The Bonati Spine Institute parts ways with other spine surgical facilities. Our success rate in alleviating pain from previously failed back surgery is unmatched by any other surgery center.
The Bonati Spine Institute has patented instruments and techniques for spinal hardware removal to correct problems from previous failed traditional open back surgery and spinal fusions. These procedures may include:
A laser discectomy is a procedure in which the diseased portion of the disc that is causing nerve compression is removed using specially adapted patented endoscopic instruments, and a laser is used to shrink and remodel the remaining disc.
A laminectomy/laminotomy is a decompression surgical procedure performed to relieve pressure on spinal nerves caused by narrowing of the spinal canal. The surgery is designed to relieve pressure (decompress) on the spinal cord or spinal nerve roots through the widening of the spinal canal. The procedure is carried out by removing or trimming part of the lamina (roof) of the vertebrae in the compressed area. The removal of part of the lamina creates an opening for the compressed nerves, relieving pressure on the nerve roots and reducing inflammation. The partial removal of the lamina may also allow the surgeon to remove any bone spurs or damaged tissue causing pain and inflammation.
The Bonati foraminotomy/foraminectomy is performed to relieve pressure on compressed nerves at the site of the intervertebral foramina (neural foramen). The Bonati Foraminotomy involves a very small incision through which the patented Bonati tube system is inserted to view the surgical area using endoscopic assistance. Instrumentation is passed through the tubular system to remove the small portion of bone or disc material compressing the nerve(s).
Re-exploration Of Spinal Fusion
Fusion surgeries can create abnormal anatomy in the spine, specifically large masses of bone or scar tissue that can press on nerves. An Exploration of Spinal Fusion corrects compression of nerves caused by a failed open fusion surgery. During the procedure, the surgeon utilizes a C-arm fluoroscopy, which allows him to mark the best skin entry point for the procedure. Next, a small incision is made, and a series of tubes are inserted, through which a small scope and camera are inserted, which allow the surgeon to identify the hardware, bone, and scar tissue causing the nerve compression. Then, specialized instruments are used to remove bone and scar tissue. Both approaches create a space for the nerve to be freed, and restore the natural anatomy of the spine. If needed, The Bonati Spine Institute’s patented methods and surgical instrumentation are used to remove orthopedic hardware and fasteners such as pedicle screws.
Prevention & Self-Care
As FBSS is linked to post-surgery development, it may not be entirely preventable. Still, there are many ways you can minimize the risks, such as:
- Following all post-operative instructions
- Completing physical therapy and rehabilitation if required
- Eating a healthy diet
- Lifestyle changes, such as quitting smoking and decreasing alcohol consumption
If you believe you are experiencing FBSS, explore your treatment options at our spine center in Tampa, FL, to determine if spinal surgery is the best option to alleviate your pain from FBSS.