Failed back surgery syndrome (FBSS) is a difficult diagnosis to deal with. If you’ve had surgery to treat your back pain, you were surely hoping it would bring relief. But with FBSS, you can have persistent or recurring back or leg pain after back surgery.
“People describe it as deep and achy pain, muscular tightness, burning back pain or ‘it just hurts, all the time,’” said Michael Prim, MD, a neurosurgeon with Banner Brain & Spine. “People often can’t get comfortable and are only able to stand for a few minutes before needing to sit down, and then can only sit for a short time before they need to stand.”
With FBSS, you may also have other symptoms that can impact your quality of life, such as:
- Limited mobility
- Muscle weakness
- Tingling or numbness
- Difficulty with daily activities
With FBSS, you have chronic pain, usually in the lower back, that isn’t explained by fractures, spinal instability or stenosis (narrowing of the canal around the nerves).
It can develop due to:
- Incomplete healing
- Nerve damage
- Scar tissue formation
- Recurring herniated discs
- Other underlying spinal conditions
FBSS is a complex condition, and the causes and symptoms can vary from person to person. “It’s a tough diagnosis for both patients and physicians,” Dr. Prim said. “As a spine surgeon, I want to help people and want them to have good outcomes. I never like diagnosing failed back surgery syndrome, even on people I haven’t operated on.”
If you have FBSS, you shouldn’t lose hope. There are other options that can help treat it.
Diagnosing failed back surgery syndrome
If you think you might have FBSS, you’ll want to see a health care provider who specializes in spine care and pain management so you can get a comprehensive evaluation. “To diagnose failed back surgery syndrome, we need to rule out all other causes of back pain,” Dr. Prim said.
To diagnose FBSS, you’ll need a combination of assessments. Your doctor will likely consider:
- Medical history, including details about treatments and the timeline of your symptoms. “This helps tease out any clues about what’s causing your pain,” Dr. Prim said. Be sure to let your doctor know if you’ve had any recent trauma, such as falls, accidents or even bumps into furniture.
- Previous surgery with other doctors: Your doctor will want to know what your symptoms were before that procedure and how they have changed. “From a surgeon’s perspective, we want to determine if the previous diagnosis was correct and if the appropriate procedure was performed,” Dr. Prim said. “It’s possible that everything was correct, but the biomechanics of your spine changed, and you have new pain for a different reason.”
- Physical examination to look for any signs of nerve impingement, muscle weakness or limited range of motion. “With symptoms such as leg pain or weakness, we want to investigate further in case there’s a surgical treatment option,” Dr. Prim said.
- Symptoms: Knowing the location, intensity and duration of your symptoms and any factors that make them better or worse can help in understanding the underlying cause of your pain.
- Imaging tests such as X-rays, magnetic resonance imaging (MRI) or computed tomography (CT) can help providers visualize the spine and look for any structural abnormalities, such as recurring herniated discs, spinal stenosis or spinal instability.
- Nerve studies like electromyography (EMG) or nerve conduction studies (NCS) can evaluate nerve function and identify any nerve damage or compression.
- Diagnostic injections such as selective nerve root blocks or facet joint injections can help determine if a specific spinal structure is the source of your pain.
- Second opinion: In complex cases or when a definitive diagnosis is challenging, seeking a second opinion from a provider who specializes in spine care or pain management can give you additional insights and help confirm the diagnosis.
Treating failed back surgery syndrome
If you’re diagnosed with FBSS, your doctor will talk to you about available treatment options. They can include:
- Physical or occupational therapy
- Pain management techniques such as medications, nerve blocks or epidural injections
- Spinal cord stimulation, where a small paddle provides an electrical signal to the spinal cord that blocks the pain signals from the back to the brain
- Chiropractic care
- Acupuncture
- Specialized exercises to improve mobility and alleviate pain
Some people find relief through alternative therapies such as yoga, massage, mindfulness-based stress reduction or complementary treatments like herbal supplements or nutritional therapies. If you’re interested in exploring these options, talk to your health care provider to learn more about how they might benefit you.
Quitting smoking can also help with FBSS, and with back pain in general. “We all know that smoking is bad for your heart and lungs,” Dr. Prim said. “It turns out that smoking is terrible for your back as well.” Smoking makes your discs, bones and joints degenerate more quickly than usual. Smoking constricts your blood vessels and limits the oxygen supply to your tissues. “This chronic state of low oxygen leads to advanced degeneration and pain in smokers compared to non-smokers.”
In some cases, revision surgery or additional procedures could address the underlying cause of FBSS. Surgery could remove scar tissue, decompress nerves or stabilize the spine. Surgery is typically considered as a last resort, after careful evaluation.
“Many people with failed back surgery syndrome request more surgery to make their pain go away, but sometimes none of the surgical procedures I can offer them will help,” Dr. Prim said. “It’s tough to be told that there is a high likelihood that your back pain will never go away. But undergoing surgery may not be the best option, with all the risks that entails and still having your chronic pain afterward. If a surgeon tells you they can’t help you with surgery and offers other things to try, understand they have your best interests in mind.”
It can be challenging to manage the physical and emotional aspects of FBSS, so you’ll want to make sure you include supportive care and coping strategies as part of your treatment plan. You may want to consider psychological counseling, support groups, pain management programs and self-care practices such as relaxation techniques, stress reduction and maintaining a healthy lifestyle.
The bottom line
FBSS is a challenging condition, but it’s not without hope. Everyone’s experience is unique and finding the right treatment options could take time and patience. It’s crucial to consult with health care providers who specialize in managing FBSS, keep the lines of communication open, ask questions and participate in the treatment planning process. Be sure to prioritize self-care — it can help you manage your symptoms and improve your quality of life.
If you would like to connect with a health care professional who can evaluate and diagnose your back pain and work with you to develop a treatment plan, reach out to Banner Brain & Spine.
