If you have heard of failed back surgery syndrome, you likely fall within one of two groups of people. Either you have had back surgery that has failed or you are preparing for your first back surgery and are worried that it may fail. In either case, your concern is valid. Despite surgeons’ best efforts, a certain number of people will not find relief from back surgery. In some cases, people will develop a condition called failed back surgery syndrome or FBSS.
Failed back surgery syndrome
Failed back surgery syndrome is a condition in which someone continues to have back pain despite having had back surgery. Failed back surgery syndrome occurs in about 5% of back pain surgeries regardless of the skill of the surgeon or the patient’s diagnosis. Nevertheless, there are some ways to avoid failed back surgery syndrome, or at least minimize your risk of having failed back surgery.
Avoiding failed back surgery syndrome the first time
If you have never had spine surgery and are concerned about failed back surgery syndrome, your best chances of avoiding residual back pain is by having the most successful back surgery possible. There are many ways to increase your chances of a successful surgery:
- Find an orthopedic surgeon or neurosurgeon that has completed a spine surgery fellowship
- Get as healthy as you can before surgery
- Stop smoking!
- Exercise as much as is safe and tolerable for you
- Get COPD, diabetes, high blood pressure, and other chronic medical conditions under control
- Make sure your surgeon is treating a specific back pain diagnosis rather than performing “exploratory” spine surgery
- Make sure you have food and medicine available at your home for the recovery
- Before surgery, recruit people to help you at home during your recovery
- Ask your surgeon if they are performing a surgery with a high success rate
- The most predictable and therefore successful surgeries for back pain are discectomy and spinal fusion
- Follow all postsurgical rehabilitation and recovery recommendations.
Treating failed back surgery syndrome once it has happened
Failed back surgery syndrome is the bane of spine surgeons and patients alike. It is terribly difficult to treat and is resistant to most forms of therapy and surgery. Surgeons are unhappy because they cannot help their patients and patients are miserable because they have to live in daily pain. In other words, it is a terrible condition. Moreover, there are very few, if any, specialists in treating failed back surgery syndrome. A repeat surgery may or may not be the best solution. If a consistent source of pain can be identified using clinical and radiological testing, then a second surgery to treat failed back surgery syndrome may be helpful.1 If the residual back pain is nonspecific, physical therapy, pain management, and other conservative measures are likely to be safer and more effective.
- Assaker R, Zairi F. Failed back surgery syndrome: to re-operate or not to re-operate? A retrospective review of patient selection and failures. Neurochirurgie. Mar 2015;61 Suppl 1:S77-82.