What is Failed Back Surgery Syndrome?
Failed Back Surgery Syndrome (FBSS) is not actually a syndrome but the term used to describe recurring and/or persistent pain in the low back, leg or both after spinal surgery. It’s incredible that 10-46% of people have FBSS. Specifically, the failure rate for microdiscectomy surgery is 19-25% while lumbar fusion has a failure rate of 30-46%.
It’s important that you have the right expectations about surgery and also that you understand the risks that surgery imposes. In addition, we strongly recommend that before you consider elective spinal surgery, you exhaust all conservative measures such as physiotherapy, chiropractic care and other forms of rehabilitation with a trusted and trained expert.
When To Get Low Back Surgery
- Progressive wasting or weakening of lower limb muscles
- Progressive loss of coordination, balance and gait function
- Loss of bowel or bladder function
- Progressive loss of sensation down your legs
- Intense pain that is resistant to conservative management
- 3-6 months of conservative therapy has failed to make any signs of progress. If you are slowly progressing with conservative management options then you should continue to pursue these options. Conservative care includes chiropractic treatment, individualized prescriptive exercise, McKenzie protocol delivered by a trained professional, traction, acupuncture and physical therapy.
What increases the likelihood of Failed Back Surgery Syndrome?
- You have an open workers compensation claim regarding your lower back injury.
- You are involved in an ongoing court case regarding your lower back injury.
- You have had spinal surgery before.
- Pre-existing degenerative disc disease or other conditions caused by wear and tear in your back overtime.
- Depression, anxiety and hypochondriasis and somatization.
- X-rays, MRI or CAT scan findings that do not explain your pain or fit your clinical presentation.
- Surgical errors such as operating on the wrong spinal segment or the wrong disc.
- Fracture that was caused by surgery.
- Pathology that is found during surgery but is inoperable such as end plate fractures, stenosis and facet joint osteoarthritis.
- Prolonged retraction. During surgery, the surgeon must cut through a thick layer of muscles in order to expose the vertebrae/disc and that muscle has to be pulled out of the way and held there with a clamp. This is called retraction of the muscle.
- Surgical Scarring: Scar tissue can increase pain and limit mobility at the surgical site. It can also cause nerve tissues to stick to other tissues and this can result in neuropathic pain. Scar tissue can interfere with circulation and drainage of fluids.
- Complications after surgery such as infection or hematoma.
- Non-fusion: During healing, the vertebra fail to fuse together.
- Arachnoiditis: Inflammation of the outer covering of the spinal cord.
Unfortunately, FBBS is far too common. Some cases are doomed right from the beginning while others are just a result of bad luck. The best advice is to give conservative treatment options the best shot that you possibly can. Work with a trusted health professional such as a chiropractor or a physiotherapist either to prevent surgery or to be in the best shape before surgery. Also, once safe to do so, be sure to participate in a post surgical rehabilitation program with your chiropractor or physiotherapist so that you can regain your core strength and minimize the scar tissue.
The chiropractors and physiotherapists at Rebalance Sports Medicine in downtown Toronto can help you. If you are suffering from low back pain and want to avoid surgery contact us today. Hope this helps you avoid Failed Back Surgery Syndrome.