From Anne Asher,
Your Guide to Back & Neck Pain.
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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. Because of this, there is no definitive guarantee that back surgery will remove back pain.

A. When back surgery fails to remove the pain, the result is a condition known as failed back surgery syndrome, or FBSS.

The incidence of FBSS ranges between 5 and 50%, according to a study done in 2005 in Prague, Czech Republic. The author of the study attributes the high percentage of FBSS cases in part to the rise in number of surgeries performed. 1

Failed back surgery syndrome can be due to a number of factors that doctors and researchers are still discussing. These include:

• Scar tissue that forms around the surgery site, interrupting normal neurological functioning.
• The technicalities of the operation are not successful, the performing surgeon had poor technique, and/or there is iatrogenic injury present.
• The surgery is not performed at the site that causes the pain.
• The surgery performed is not actually necessary.
• The patient is a poor fit for a successful surgery.
• The diagnosis was incorrect.
• Complications of surgery arise.

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.

Treatment options for FBSS are dependent upon:

• Thorough assessment using MRI, CT or other appropriate imaging techniques.
• Consideration of the patient’s concurring health problems and extenuating life circumstances.
• Medical history.
• Physical examination.

Generally, treatment focuses on conservative measures first, such as rehabilitation and pain management, before another surgery is considered. The conservative measures may include exercise, manual therapy, spinal cord stimulators and/or an implanted pump to deliver pain medication. Sometimes further surgery is not a consideration in the patient’s pain management future.

Bibliography
1 Chrobok, Vrba, Stetkarvoa. Selection of surgical procedures for treatment of failed back surgery syndrome (FBSS). Chir Narzadow Ruchu Ortop Pol. 2005.
2 Long, D.M. Failed back surgery syndrome. Neurosurg Clin N Am. 1991 Oct.
3 Guyer, Patterson, Ohnmeiss.Failed Back Surgery Syndrome: Diagnostic Evaluation. J Am. Acad Orthop Surg. 2006 Sept.
4 North, Campbell, James, Conover-Walker, Wang, Piantadosi, Rybock, Long.Failed back surgery syndroms: 5-year follow-up in 102 patients undergoing repeated operation. Neurosurgery. 1991 May
5 Talbot, Lina. Failed back surgery syndrome. BMJ 2005 Oct.
6 Rapid Responses to: Talbot, Lina Failed back surgery syndrome. BMJ 2005 Oct.
7 Failed back surgery syndrome: What is it and how to avoid it. Spine-Health website.
8 Causes of failed back surgery syndrome. Spine-Health website.