Failed Back Syndrome

Failed back syndrome – also known as post-laminectomy syndrome  - is a term used to describe a variety of conditions that may present after surgery or other treatments.

The cause of the post-surgical pain may be the same as for the pain that was present pre-surgery – that is,  the surgery may simply have failed to solve the original issue. However, there are other possible causes that may stem from the surgery itself. The pain could be caused by scarring on nerves rooted in the spinal cord. This condition is known as radiculopathy, i.e. pain radiating from an overactive nerve root. Surgery can also result in a change in the patient’s gait or posture. This change can be accompanied by inflamed or irritated joints, another possible source of pain. Similarly, surgery may have caused the muscles to align and function in a different way, triggering myofascial pain related to muscle soreness. A patient may be predisposed to the development of Failed Back Syndrome due to systemic disorders such as diabetes, autoimmune disease and peripheral blood vessels (vascular) disease. Smoking is also associated with routine failure of spinal surgery.

Failed Back Syndrome is technically not a syndrome – rather, it is a generalized term that describes the condition of back or spine surgery patients with unsatisfactory results. Common symptoms associated with Failed Back Syndrome include diffuse, dull and aching pain involving the back and/or legs. Abnormal sensibility may include sharp, pricking, and stabbing pain in the extremities.

The diagnosis of failed back syndrome varies according to the way the pain presents in the individual patient. As with other types of back pain, Computed Tomography (CT) scans, MRI scans, and X-rays may be used to investigate the structures of the back and attempt to identify the source of the pain. Minimally invasive spine procedures may be used to isolate the source of the pain. These include epidural injections of steroids or pain medication, and may also provide the patient with some pain relief.

Treatments for Failed Back Syndrome include:

• physical therapy (which may be in addition to other therapies as part of any treatment plan)
• minor nerve blocks
• transcutaneous electrical nerve stimulation(TENS) – a device placed on the skin over the back
• behavioral medicine
• non-steroidal anti-inflammatory (NSAID) medications
• membrane stabilizers
• antidepressants
• spinal cord stimulation, and
• intracathecal morphine pump - a small pump and tube are implanted in the body to deliver small, regular doses of pain medication directly to the space surrounding the spinal cord

In addition, the use of epidural steroid injections may be helpful in some cases. The targeted anatomic use of a potent anti-inflammatory anti-TNF therapeutics is being investigated.