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Failed Back Surgery Syndrome

What is FBSS (Failed Back Surgery Syndrome)? Following spinal surgery, many patients will experience new, recurrent, or persistent pain in the legs or lower back. In this article, we will cover how to manage and optimize the outcomes of Failed Back Surgery Syndrome. In a 2019 study by Philippe Rigoard, Kliment Gatzinsky, Jean-Philippe Deneuville, Wim Duyvendak, Nicolas Naiditch, Jean-Pierre Van Buyten, Sam Eldabe they outlined ‘A Consensus Statement on Definition and Outlines for Patient Assessment’.

When it comes to diagnosing patients for Failed Back Surgery Syndrome it becomes an embattled topic. FBSS is a complicated condition with complex pathophysiology due in a large part because it includes various etiologies and pain characteristics that affect mental and social well-being along with functional movements. Managing this type of complicated syndrome has been studied heavily by the medical community and leading researchers. In this summary, we will look deeper at the FBSS syndrome to transpose a mechanistic theory to better understand the management side. This will be split into two different sections for back pain and leg pain.

FBSS Back pain component

For the back pain component, it’s crucial to have a comprehensive assessment of all the possible sources for the nociceptive pain characteristics. Looking at the stability and posture of the spine in distinctive planes along with certain palpitations on different paravertebral areas or vertebral to clearly identify any pain triggers. The researchers looked at pain generators of the spine which include disc complex, facet complex, and myofascial syndromes, facet complex, and disc complex. Each one of these factors has its own properties that can influence FBSS. A big factor that causes spinal instability or overloading of the vertebral column that triggers tensions and displacements comes from muscle pain points. The facet complex comprises many structures and when dysfunction is present, it can advance biomechanical faults. Spinal stenosis and nerve entrapments are caused by the narrowing of the facet joints. Disc pain is another pathology that affects the vertebral body which ordinarily produces pain in an upright position due to the compressive forces. 

FBSS Leg pain component

This section looks at verifying radicular lesions that could show neuropathic pain and rule out other causes of pain. If you have the presence of any sensory dysfunction fused with any motor deficits, then pain can be an indication of a nerve lesion which then causes neuropathic pain. Outcome measures and diagnostic tools, LANSS and DN4, have also been used to confirm neuropathic pain which has successfully been used in daily clinical practices. If you get a positive result using these diagnostic tools it’s a powerful indicator of spine surgery failure. The researchers also recommend that an examination of the SI Joints, Knee, and hip are critical to rule out a diagnosis of sciatica and anterior thigh pain. Careful palpation and vascular examination also needs to be performed to determine if intermittent claudication occurs when walking or piriformis syndrome at the gluteal region. 

Aside from the leg pain and back pain components, other assessments should be considered as well according to the researchers. A psychosocial assessment for psychological factors can also have an effect on pain perception and clinical outcomes as well as a radiological assessment to exclude new indications for a new operation. A multidisciplinary approach is most appropriate for patient assessment in order to choose the best treatment options. There is some debate about the negative connotation surrounding the term (failed back surgery syndrome), which directs blame on surgeons/surgery, there have been other nomenclature developed such as chronic postsurgical pain, postoperative persistent pain syndrome, rebound radicular syndrome, and post-laminectomy syndrome.

If you have any questions about FBSS, please contact Premier Therapy Solutions and schedule a consultation. Dr. Lisa Corsa, DPT, MSPT, DO Manual Osteopath, ATC, LAT, CPT, CKTP, LSVT-BIG has been highly successful at compassionately treating patients with FBSS when all other options have been exhausted. 561-672-7613

Failed Back Surgery Syndrome

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