Failed Back Spine Surgery

We specialize in delivering advanced treatment for Failed Back Surgery Syndrome (FBSS). Our approach stands out with a focus on cutting-edge solutions and personalized care. Utilizing state-of-the-art, minimally invasive procedures such as spinal cord stimulator, we address the intricate challenges of FBSS directly, targeting persistent issues after surgery. Our expert team tailors individualized treatment plans, ensuring precision and effectiveness in every case. By combining innovation with a commitment to patient well-being, our clinic provides an advanced and transformative path for individuals grappling with the complexities of Failed Back Surgery Syndrome, offering a beacon of hope and relief in the realm of spine and pain management.

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    Failed Back Spine Surgery

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    Failed Back Surgery Syndrome (FBSS) also known as Post Laminectomy Syndrome (PLS) is not a diagnosis, but rather a general term to describe a variety of chronic pain syndromes experienced by patients after open spine surgery (1). The exact cause of Post-Laminectomy Syndrome is unknown, however one prominent theory points to:

    • Removal of lamina (spine bone) causing muscles to proliferate & formation of adhesions with unprotected dural membrane since many important structures like ligamentum flavum is removed in open spine surgery (Laminectomy). These adhesion may also involve nerve roots & give rise to severe pain(3).
    • Arachnoiditis or inflammation within the protective layers of the spinal cord.
    • Surgical intervention at the wrong spinal level (the operated level may not be source of pain)

    Because of the diversity of potential causes and the variety of different chronic pain syndromes that can result as a consequence of FBSS, the condition can be a difficult one to treat.

    Failed Back Surgery Syndrome Diagnosis and Treatment

    Diagnosis of failed back surgery syndrome is made following surgery, as a doctor recognizes a developing pattern of chronic pain and poorer surgical outcomes than expected. A physician may order laboratory or imaging studies to identify possible inflammation or other structural abnormalities where the lamina was removed. Treatment options are situation-dependent and must be tailored to each patient individually. Some of the possible treatment options include (1,4,5):

    • Endoscopic Discectomy : Not choosing open spine surgery whenever possible is best way to avoid failed back surgery. Many advanced minimally invasive approaches are available like Endoscopic discectomy, which not only give better results but also avoids failure like FBSS.
    • Racz Procedure / Adhesiolysis is the disconnection of fibrotic scar tissue after surgery. During adhesiolysis, the scar tissue can be mechanically removed with special instruments or chemically removed via injection of saline or other solutions.
    • Spinal cord stimulation via placement of electrodes into the epidural space of the spinal cord thought to be associated with the pain may be appropriate for some patients. The electrodes apply an electric current to interfere with pain conduction pathways. While the outcomes of spinal cord stimulation can be good, there is a high rate of complications associated with electrode implantation.
    • Intrathecal infusion pump are implanted delivery devices which deliver one of several drugs to the spine. There are several pain control receptors on the spinal cord and these medications work directly on these receptors to block pain. It is used to deliver medications directly to the spinal cord.
    • Opioids can be used for pain management, however responses are unpredictable. The side effects of long-term opioid use can be serious, and long-term outcomes aren’t well understood. It is strictly monitored by physician.

    Failed back surgery syndrome can affect patients long-term, and significantly affect an individual’s lifestyle and ability to return to work. With proper treatment, however, pain can often be reasonably managed.

    Dr. Manish Raj

    MD, DA(Gold Medal), FENDS, FIAPM, FISP, FPM

    MEET YOUR DOCTOR

    • 5000+ Interventional Spine & Pain Procedures
    • 10000+ OPD/Day Care Procedures
    • Pioneer in Endoscopic Discectomy in India
    • 2000+ successful cases of Endoscopic/LASER Spine surgery done
    • International Faculty for Endoscopic Spine Surgery
    • Trained in Germany, South Korea and India

    Qualification and Training

    • MD, DA (Gold Medal), FENDS, FIAPM, FISP, FPM
    • Endoscopic spine & interventional pain consultant
    • Fellow of endoscopic spine surgery (S.Korea)
    • Fellow of Indian Academy of Pain (ISSP)
    • Fellow of interventional spine & pain (PCI)
    • Fellow of pain management ( Germany )

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    Several factors could contribute to a previous back surgery not providing the expected relief. These may include misdiagnosis or incomplete assessment of the underlying cause of the back pain, leading to the surgery targeting the wrong problem. Additionally, complications during surgery, such as nerve damage, inadequate decompression, or incomplete removal of damaged tissue, could result in persistent or worsened symptoms. Poor post-operative rehabilitation, including inadequate physical therapy or failure to address underlying muscle imbalances or structural issues, may also contribute to ongoing pain and limited function. Furthermore, the natural progression of degenerative conditions in the spine or the development of new issues over time could undermine the effectiveness of the initial surgery. It’s essential to consult with a healthcare provider to evaluate the reasons for the previous surgery’s failure and explore alternative treatment options tailored to your specific needs and circumstances.

    Failed Back Surgery Syndrome (FBSS) can develop for several reasons, including misdiagnosis of the underlying cause of back pain, surgical complications such as nerve damage or incomplete decompression, inadequate post-operative rehabilitation, progression of degenerative conditions in the spine, development of new issues over time, and psychological factors such as depression or anxiety amplifying pain perception.

    Yes, alternative non-surgical treatments for Failed Back Surgery Syndrome (FBSS) include physical therapy, chiropractic care, acupuncture, and there are advanced pain management techniques such nerve blocks, spinal cord stimulation, radio-frequency ablation.  The spinal cord stimulation has come out to be the best treatment modality for failed back surgery syndrome in last decade. The effectiveness of these treatments varies depending on individual factors such as the specific underlying cause of FBSS and the patient’s response to treatment.

    Yes, additional diagnostic tests such as MRI, CT scans, EMG, or bone scans may help identify the underlying issues causing persistent pain after surgery by providing detailed imaging of the spine, assessing nerve function, or detecting abnormalities in bone or soft tissue.

    Yes, there is a possibility of revision surgery for persistent pain after a previous back surgery. Potential risks of revision surgery include complications such as infection, nerve damage, bleeding, or failure to relieve pain. However, benefits may include improved pain relief, restored function, and enhanced quality of life if the underlying issues causing persistent pain are successfully addressed. It’s essential to discuss the risks, benefits, and potential outcomes of revision surgery with a healthcare provider to make an informed decision based on your specific situation.

    The long-term prognosis for persistent pain after back surgery varies depending on factors such as the underlying cause of the pain, the effectiveness of previous treatments, and individual patient factors. In some cases, persistent pain may improve with conservative treatments such as physical therapy, medication, or pain management techniques. However, if conservative measures fail to provide adequate relief, spinal cord stimulation should be the treatment of choice because of its effectiveness and recommendation for pain relief in failed back surgery. It’s essential to work closely with a healthcare provider to develop a comprehensive pain management plan tailored to your specific needs and circumstances, with the goal of minimizing pain and improving function and quality of life over the long term.

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