Failed Back Syndrome
What is failed back surgery syndrome?
Failed back surgery syndrome is when a patient experiences new, recurrent or persistent back or leg pain and disability despite undergoing a prior low back surgery. Unfortunately, a significant proportion of patients who had lumbar spine surgery continue to have persistent pain and impaired function and a low quality of life.
There are many and varied reasons for patients to have continued pain after back surgery. The diagnosis of failed back surgery syndrome requires a detailed review of past symptoms, surgeries, and current symptoms to rule out other causes of pain.
Dr. Singh evaluates the patient’s condition to determine whether the patient has failed back surgery syndrome, and whether there is any structural and possibly correctable reason for the pain.
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.
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Dr. Kern Singh, MD is an internationally renowned spine surgeon specializing in outpatient minimally invasive and motion-preserving techniques and endoscopic spine surgery at Midwest Orthopaedics at Rush and Professor in the Department of Orthopaedic Surgery at Rush University Medical Center in Chicago, Illinois. Dr. Kern is one of the nation’s Top 100 spine surgeons and beloved by his patients for his compassionate care and excellent outcomes. He welcomes nationally and internationally-based patients.
- Gatzinsky K, Eldabe S, Deneuville JP, Duyvendak W, Naiditch N, Van Buyten JP, Rigoard P. Optimizing the Management and Outcomes of Failed Back Surgery Syndrome: A Proposal of a Standardized Multidisciplinary Team Care Pathway. Pain Res Manag. 2019 Jul 8;2019:8184592. doi: 10.1155/2019/8184592. PMID: 31360272; PMCID: PMC6644221.
At A Glance
Dr. Kern Singh
- Minimally invasive and endoscopic spine surgeon
- Inventor and surgeon innovator with multiple patents in spinal surgery and instrumentation
- Author of more than 10 textbooks in minimally invasive spinal surgery
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