Fail Back Surgery Syndrome (FBSS) is the diagnosis of lumbar spinal pain appearing after a surgical intervention. A patient with FBSS may experience a worsening of pain or a new pain in the same area.
Around 51% to 84% of adults experience lower back pain during their lifetime. This has led to a 170% increase in the number of back surgeries from 1998 to 2008. However, up to 40% of patients experience Fail Back Surgery Syndrome (FBSS) after their intervention.
A survey of failed back surgery syndrome patients found that 67 of 78 patients with FBSS suffered from depressive symptoms following the initial onset of pain.
Compared with other chronic pain syndromes, including arthritis, and fibromyalgia, FBSS patients have been shown to exhibit a lower quality of life scores and higher amounts of pain, unemployment, opioid use, and disability
Physiological symptoms of FBSS can start before the surgery has even taken place. It is common for patients who later develop FBSS to experience higher rates of anxiety, depression, obesity, smoking, stenosis, fibrosis, and disc herniation.
After surgery, a patient is more likely to develop spinal stenosis, spinal instability, epidural fibrosis, or disruption of adjacent discs.
The two categories of treatments for FBSS are conservative (physical therapy or medication) and aggressive (interventional and surgical).
Opioids are commonly used to treat chronic pain despite their addictiveness. One study found that opioid overdose was the most common cause of death following lumbar fusion surgery
Surgery to fix a failed back surgery is not recommended as patients who have had multiple back surgeries have a higher chance of developing FBSS.
Physical Therapy has been found to be effective in reducing pain after back surgery. However, physical therapy must focus on developing tolerance, in a non-pain contingent fashion under the direction of an experienced physical therapist who understands the patient’s pathology, strengths, and limitations.
Epidural Injections can also be an effective treatment for several pathologies associated with FBSS.
In conclusion, Patients should receive proper education on the possible risks of lower back surgery before and after the operation.
