Failed back surgery syndrome (or failed back syndrome) is a general term to describe an unsuccessful back surgery. These patients continue to feel pain after they’ve had a surgical spine procedure and can experience a wide range of symptoms which may include chronic pain in the back, neck, or legs, which could be either dull or sharp, aching, tingling, burning, or radiating. In my case, it was a buildup of scar tissue around spinal nerve roots which caused a a considerable amount of discomfort around the surgical area.
In a recent research article entitled ‘Failed back surgery syndrome: current perspectives‘ the author references studies that estimates FBSS at anywhere between 20% to 40% depending on age of patient and type of pain. This reinforces my experience with back surgery in that pain can continue to persist in the same way, pre-surgery or you could end up with a new type of pain caused by the surgery (in my case, as mentioned above – scar tissue pain). Various publications point to several reasons for Failed Back Surgery Syndrome. These include:
Misdiagnosis: Surgery on the spine can be risky and if it’s performed to treat unrelated medical conditions then a patient’s condition can worsen. As stated in this research conducted by Robert J.Gatchel, “if the patient is misdiagnosed, the surgery is obviously incorrect and damaging. The most common misdiagnosis in these cases is arthritis misdiagnosed as a lumbar disc disease. Often, improper selection and misdiagnosis follows from inadequate pre-operative evaluation and diagnostic work-up”.
Unnecessary Surgery: If you follow this blog, you’ll know that several authors have mentioned how back surgery can be completely avoided. Dr. Sarno in Healing Back Pain and Cathryn Jakobson Ramin in her book Crooked.
extensively write about how spine surgery should be reserved for only the most severe cases. Several research papers have mentioned that proper assessment through multi-disciplinary teams is recommended before surgery is considered.
Improper Surgery: This would seem to be the most often and obvious reason for FBSS as even the best surgeons will inform their patients that there is risk involved when operating on the spine. As mentioned on this site, Steve Kerr, coach of the Golden State Warriors dealt with an unsuccessful operation when his surgeon nicked the Dura which caused a cerebrospinal fluid leak. And even if the surgery was carried out perfectly, as my experience suggest, issues like scarring can reduce effectiveness post-op. Here again is Robert J. Gatchel outlining this issue. “FBSS may also result from the presence of fragments of disc material that are not properly removed. The retained fragments may compress a nerve root, or scarring may develop around them, causing delayed onset of severe symptoms”.
One other crucial predictor of FBSS seems to be pshycosocial. Pre-existing conditions such as depression, anxiety and whether a person is a smoker can determine the effectiveness of spine surgery. This research article By James Danielle states that “A patient’s psychosocial wellbeing has a significant effect on his/her treatment outcome and pain experience such that Carragee et al.  found poor psychosocial wellbeing to be the strongest predictor of LBP disability in a study comparing morphological and social risk factors”.