Failed Back Surgery Syndrome (FBSS)

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What is Failed Back Surgery Syndrome?

Failed back surgery syndrome (FBSS) is a syndrome characterised by continuing back and/or leg pain despite undergoing lower spinal surgery. FBSS is diagnosed when the outcome of such surgery does not meet the expectations of the patient or the surgeon that were outlined before the surgery.

Who gets Failed Back Surgery Syndrome?

FBSS occurs as a complication in 5–40% of patients undergoing lower spinal surgery.

Predisposing Factors

It is thought that patients undergoing spinal surgery may be more likely to develop FBSS if they have:

Epidural fibrosis (development of hard connective tissue around one of the layers surrounding the spinal cord and part of the nerves coming from it)
Recurrent disc herniation
Instability of a segment of spine
Incorrect initial diagnosis of the back problem
Incomplete decompression (reduction in pressure on the nerve root)
Decompression at the wrong level
Poor patient selection for surgery
Arachnoiditis (inflammation of one of the layers surrounding the spinal cord and part of the nerves coming from it)
Permanent nerve root damage
Facet joint disease

Progression

The progression of FBSS varies between individuals. It is probably influenced by factors such as the underlying problem with the back before surgery, what kind of surgery was performed, why and when FBSS develops, and how it is managed.

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