Failed back surgery syndrome can result from various factors, including surgical complications, incomplete nerve decompression, scar tissue formation, nerve damage, and the development of new spinal problems.

Possibly correctable causes of persistent pain after back surgery may be incomplete decompression of the spinal cord or nerves during the last surgery, non-union, or misalignment. Other reasons for continued pain may not relate directly to the original surgery but are signs of a new problem such as adjacent segment disease, or another disc herniation and recurrent spinal stenosis.

• Chronic low back pain at or near the surgical site.
• Sharp, shooting pain down the leg
• Radicular pain that radiates down the leg
• Leg weakness
• Numbness or tingling in the legs
• Limited mobility

The diagnostic work-up for failed back syndrome is aimed at understanding the patient’s history of back problems, past treatments, surgeries, postoperative course, and current anatomy and symptoms. Dr. Singh will perform a comprehensive evaluation of the patient’s medical history, physical exam, and diagnostic testing including:

• X-Rays to check the alignment of the spine
• MRI (if there is no spinal hardware) to determine if there is any residual nerve root compression
• CT (if there is spinal hardware) to assess the bony fusion.
• Test to measure the electrical activity of muscles and nerves
• Diagnostic injections

Considering all the facts Dr. Singh will offer his diagnosis and recommendation for treatment. Failed back surgery syndrome can sometimes be a result of unrealistic expectations of what surgery can do. It is important for surgeons and patients to have honest discussions before surgery about what to expect from surgery including how much improvement a patient may be able to expect with surgery. Sometimes, even if a surgery is done perfectly, there will be residual pain, though it may be improved.