There are many factors that can cause or lead to failed back surgery syndrome, including a recurrent disc herniation, compressed nerves, altered joint mobility, scar tissue, muscle deconditioning, and degeneration of facet joints or sacroiliac joints. In addition, it's possible that the surgery addressed an anatomical issue that was not the main cause of the patient's pain, and as a result the patient's pain continues—or worsens—after the surgery.
The problem of failed spine surgery has been perplexing medical experts for a long time. Even with all the unknowns, however, there is much you and your surgeon can do to help prevent a poor outcome after surgery.
How to reduce the changes of failed back surgery syndrome
Through many years of experience I know there are several factors that have shown to contribute to failed back surgery syndrome, and therefore I follow the protocol below to help ensure good surgical outcomes.
Before the surgery:
- Always treat patients non-operatively first. For most people, a committed effort at non-surgical treatment, including physical therapy, will help reduce their pain.
- Make sure the patient is correctly diagnosed—meaning that the true cause of the patient’s pain has been accurately identified.
- Provide a thorough pre-operative evaluation.
- Make sure the surgery is the right one for the patient.
- Appropriately educate and set expectations for the patient, including pre-operative psychological evaluations.
During the surgery:
- Take all proper precautions to minimize intra-operative issues.
After the surgery:
- Keep a close eye on postoperative recovery.
- Make sure any postoperative pain is appropriately managed.
- Work closely with the patient's interdisciplinary care team of physical therapists, occupational therapists, etc.
What you can do to prevent FBSS
If you're considering spine surgery, it's important to sit down with your surgeon and determine how he or she actively attempts to minimize the risk for failed back surgery syndrome.
In addition to the above outline, there are many things you can do to improve your chances of having a good outcome from spine surgery. For example, research your surgeon and ask good questions, make sure you follow through with all postoperative instructions, including physical therapy and rehabilitation. Reading the articles and watching the videos on this website is a good start.
Finally, if you already have failed back surgery syndrome, it is not necessarily the end of the road. There exist many alternative treatment approaches to deal with this syndrome, but once again one size does not fit all. It is important to find a surgeon who has experience in treating patients with FBSS and can offer you multiple treatment options.