Failed Back Surgery Syndrome (FBSS)

Failed Back Surgery Syndrome (FBSS)

   Failed Back Surgery Syndrome (FBSS) sometimes referred to simply as Failed Back is a condition in which patients continue to experience back pain or radiating leg pain after spinal surgery. This may occur even after one or multiple operations, when the outcome is not as expected or when pain returns sometime after the procedure.

   FBSS does not necessarily mean that the surgery itself was technically unsuccessful. Rather, it refers to the persistence or recurrence of pain that has not improved as anticipated.
Common contributing factors include:

• Other underlying spinal pathology that remains unresolved
• Epidural fibrosis (scar tissue around the nerves)
• Malunion or abnormal bone fusion
• Implant migration or instability
• New problems at adjacent spinal levels (Adjacent Level Disease)
• Psychological factors or central sensitization

Incidence

   Research published in Pain Physician and Spine Journal indicates that:

• The incidence of FBSS among postspinal surgery patients is approximately 10 - 40%.
• FBSS is one of the leading causes of chronic neuropathic pain and remains a complex condition to manage.

Management of FBSS

   Effective treatment of FBSS requires accurate diagnosis and a multimodal approach beyond repeat surgery.

1. Pain Intervention

• Epidural Steroid Injection (ESI)
• Transforaminal Epidural Injection (TESI)
• Caudal Lysis of Adhesions (e.g., Racz Procedure)
• Spinal Cord Stimulation (SCS)

2. Multidisciplinary Pain Program

• Specialized physical therapy
• Cognitive Behavioral Therapy (CBT)
• Pharmacologic pain management (e.g., Gabapentin, SNRI, Tramadol)

3. Revision Surgery: Reserved for specific indications such as:

• Implant failure
• Pseudarthrosis
• Clearly demonstrated foraminal stenosis on MRI or CT

Sapiens Pain Hospital and FBSS Care

    At Sapiens Pain Hospital, our dedicated "Interventional Pain Management" and Spine Surgery teams work collaboratively through a multidisciplinary approach.

• Comprehensive pain source evaluation using MRI, EMG, and Nerve Studies
• Advanced interventional techniques, including:
  • Spinal Cord Stimulation (SCS)
  • Dorsal Root Ganglion (DRG) Stimulation
  • Intracept Procedure

• Continuous follow-up and personalized treatment adjustments

     Our specialized equipment including Fluoroscopy, Ultrasound, Neuromodulation Systems, and Pain Mapping Technology enables highly precise and safe procedures for optimal patient outcomes.

References
1. Bicket MC, et al. (2013). Predictors of outcomes after lumbar discectomy and laminectomy. Pain Physician, 16(3): E34560
2. Kumar K, et al. (2008). Spinal cord stimulation is effective in the management of FBSS. Neurosurgery, 62(6): 13531363.
3. Taylor RS. (2005). Spinal cord stimulation in the treatment of FBSS. Eur Spine J, 15(4): 50713.