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Failed Back Syndrome

What does “Failed Back Syndrome” mean?

Failed back syndrome is a term sometimes used to describe the outcome from a spine surgery which is not what was expected.

The surgery basically “failed” to meet the patient’s and surgeon’s expectations.

This often means that patients still have significant symptoms after the spine surgery, which were hoped to be resolved by the surgery.

Why is the term “Failed Back Syndrome” used?

The term “Failed Back Syndrome” or “Post-Laminectomy Syndrome” is often used by spine specialists as a general term and not a specific spine diagnosis.

It is not a specific “Syndrome”, but rather many different conditions which can happen as a result of spine surgery.

The term is generally used to describe patient outcomes which are not satisfactory to the patient and the surgeon.

The term “Failed Back Syndrome” is used to create a category for all patients who are dissatisfied with the outcome of their spine surgery.

Why does a Failed Back Syndrome happen?

There are many different reasons for this to happen. A lot depends on which type of spine surgery was performed and if there was more than one spine surgery. Generally, the more spine surgeries a patient undergoes, the more likely it becomes that a Failed Back Syndrome may eventually happen.

Here are some of many reasons why a Failed Back Syndrome may happen:

  1. Spinal fusion which did not heal (Pseudoarthrosis).
  2. Spinal fusion which is causing pain either from the surgery itself, the metal hardware placed, or the bone implants.
  3. Spinal fusion where the disc next to the fusion is degenerating (Adjacent Segment Disease)
  4. Spinal Fusion where the metal hardware is either lose or has broken.
  5. Spine surgery where an infection happened after the surgery (Discitis, Spinal Abscess, Vertebral Osteomyelitis)
  6. Spine surgery where the scarring is causing pain (Spinal Scarring/Adhesions)
  7. Spinal muscle pain from opening the spine during surgery.
  8. Spinal surgery where the facet joints are stressed from the surgery.
  9. Spine surgery which took a long time to complete. Very long spine surgeries can cause problems with chronic muscle pain and scarring.
  10.  Spine surgery which flattens the spine curvature (Flat Back Syndrome)
  11.  Spine surgery where a patient suffers from Arachnoiditis.

Can a Failed Back Syndrome be avoided?

There is no guaranteed way to prevent a Failed Back Syndrome from happening during a spine surgery.

It is important to have good communication with the spine surgeon about:

  1. Expectations from the surgery
  2. Possible risks and complications from the surgery
  3. Possible benefits from the surgery

What are some possible treatments for Failed Back Syndrome?

Since there are many possible reasons why patients suffer from a Failed Back Syndrome, there are also many different ways to treat it. It is generally best to see if the specific reason (condition) for the Failed Back syndrome can be identified. This way, the treatments can be tailored for the specific condition.

Here are some examples of treatments available:

  1. Non-Surgical

A. Alternative Health Care

Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition. Massage Therapy techniques can help with the muscle discomfort of thoracic degenerative disc disease.

B. Nutrition and Weight Loss

Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms.

C. Chiropractic Care

Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

D. Spine Exercises

Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility. Exercising the spine can be a form of “preventative maintenance” over time. The focus should be on spine mobility and stability.

E. Physical Therapy (PT)

PT has many modalities to offer for this condition. They can range from Manual Therapy and Exercises to Traction and Ultrasound Treatments. Keeping the spine’s mobility, strength and stability are often goals of PT. Aquatic therapy can be a very helpful PT intervention.

F. Self Help Tools

Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories. Sometimes back braces can add stability to the spine. However this must be balanced against relying too much on the brace, which could weaken the muscles over time.

G. Spine Medications

Similar to other spine conditions, medications which help with spine pain can help with the symptoms from a Failed Back Syndrome. While there is no “best medication”, the spine specialist can prescribe one or a combination of the medications below. Here are some examples of groups of medications:

  1. Non-Steroid Anti-Inflammatories Drugs(NSAIDS)
  2. Muscle Relaxants
  3. Pain Killers
  4. Nerve Pain Medications
  5. Antidepressants
  6. Sleep Agents
  7. Topical Medications

 

H. Injections and Procedures

Spine injections can help in some patients. This is highly dependent on the specific diagnosis causing the Failed Back Syndrome.

  1. Lumbar Interlaminar ESI

      2. Lumbar Transforaminal ESI

      3. Lumbar Nerve Root Block

      4. Lumbar Facet Joint Injection

      5. Lumbar Medial Branch Block

      6. Lumbar Facet Joint Radiofrequency Rhizotomy

      7. Lumbar Trigger Point Injection

      8. Lumbar Muscle Block

      9. Implanted Devices for Pain Relief

Implanted devices for pain relief are sometimes considered if other spine treatments have been unsuccessful in controlling severe spine pain. Here are some of these devices:

  1. Lumbar Spinal Cord Stimulation
  2. Thoracic Spinal Cord Stimulation
  3. Lumbar Intrathecal Pain Pump Implantation

 

      2. Surgical Care

The surgical care for Failed Back Syndrome can vary widely depending on the specific condition which is causing it.

Here are some surgeries which are done for this condition:

  1. Lumbar Fusion
  2. Lumbar Decompression
  3. Lumbar Discectomy
  4. Lumbar Dynamic Stabilization