Failed Back Syndrome: Travel to India and get New Hope

Failed Back Syndrome

Failed Back Syndrome (or Failed Back Surgery Syndrome): a description of chronic or recurrent pains following spinal surgery, typically a laminectomy, discectomy, or spinal fusion. It is not a disease, but is rather a group of symptoms persisting even after surgery.

Overview

• Happens when the desired outcome of spine surgery is pain relief rather than being attained.
• Can contribute to chronic back pain, leg pain or both.
• May develop shortly after operation or even months or years.

Failed Back Syndrome causes

The following is a decisive list of the etiology of Failed Back Syndrome (FBS/FBSS):

Surgery-related causes

• Stagnant disc substance - partial elimination of herniated disc.
• Recurrent disc herniation - disc re-herniates in the same location.
• Scar tissue (epidural fibrosis) - post-operative scar which is pressing nerve roots.
• Nerve injury in operation - unintentional injury to nerve roots.
• Incorrect level surgery - surgery done on a wrong level of the spine.
• Instrumentation failure - broken screws, rods or cages following spinal fusion.

Spine-related causes

• Spinal instability - too much movement at level after surgery.
• Adjacent segment degeneration - wear and tear above or below fused region.
• Foraminal stenosis - constriction of untreated or partially treated nerve routes.
• Pseudoarthrosis- loss of fusion subsequent to spinal fusion surgery.

Patient-related causes

• Nerve damage before surgery- nerve is already permanently damaged.
• Bad habits: diabetes, osteoporosis, slowing arthritis, etc.
• Psychological causes - depression, anxiety, inadequate coping styles that increase pain.
• Obesity, smoking, bad fitness - make healing and results worse.

Diagnostic/Selection causes

• Misdiagnosis preoperative - pain was not caused by surgery (e.g. myofascial pain, fibromyalgia, hip arthritis).
• Excessive surgery -surgery when conservative therapy would have been more appropriate.
• Inadequate education of patient - patient assumes that he/she will be pain-free after surgery and that surgery will treat chronic back pain rather than leg pain.

Failed Back Syndrome symptoms

The following is a systematized list of the symptoms of Failed Back Syndrome (FBS/FBSS):

Primary Symptoms

• Persistent back pain = pain that does not go away even after surgery.
• Radiating pain of legs (sciatica-like) → burning, shooting pain down one or both legs.
• The leg, foot, or buttock areas become numb, or tingling.
• Lower limb muscle weakness.
• The spine is stiff and less flexible.

Associated Symptoms

• Having problems with standing up or walking.
• Pain-related sleep disturbances.
• Less mobility and no capacity to do the daily activities.
• Relies on pain drugs to relieve pain.

Chronic/Psychological Symptoms

• Depression or anxiety with persistent pain.
• Failure to be treated, frustration, emotional distress.
• Exhaustion caused by both chronic pain and insomnia.

Failed Back Syndrome diagnosis

Below is a step-by-step description of Failed Back Syndrome (FBS/FBSS) diagnosis:

Clinical Evaluation

Medical history:

• Spine surgery performed (discectomy, laminectomy, fusion, etc.)
• Postoperative pain- improved, worsened, or remained the same.
• Time post-operative and the beginning of new pain.
• Symptom examination: back pain, pain in the legs, numbness, weakness, functional impairment.
• Physical assessment: neurological (strength, reflexes, sensation), gait, posture and mobility.

Imaging Tests

X-rays

• Spinal positioning, fusion success, hardware position.

MRI (with/without contrast) scan.

• Best in identifying the presence of scar tissue (epidural fibrosis), herniation of discs recurrently, compression of nerves.

CT scan

• Close bone imaging, useful in the diagnosis of fusion, hardware problems, or stenosis.

CT myelography

• Can demonstrate nerve root compression when MRI is not possible (metal implants).

Functional/Diagnostic Tests

EMG and NCS

• Determine chronic or permanent nerve damage.

Diagnostic injections/nerve blocks.

• Assist in the localization of the focal source of pain (facet joint, nerve root, sacroiliac joint).

Discography (rarely used now)

• Painful disc tests which involve injecting dye are only taken in exceptional cases.

Psychological Evaluation

• Depression, anxiety, or chronic pain syndrome screening - because psychological variables may contribute to pain perception and results.

Failed Back Syndrome treatment

The following is a list of the Best treatment for Failed Back Syndrome:

Non-Surgical / Conservative Management

(Most patients use the first-line approach)

Medications

• NSAIDs (ibuprofen, diclofenac) - decreases inflammation and pain.
• Neuropathic agents of pain (gabapentin, pregabalin, duloxetine, amitriptyline).
• Muscle relaxants for spasms.
• Opioids - reserved, when other treatment options are not effective.

Physical Therapy/Rehab

• Strengthening, stretching and posture training.
• Hydrotherapy, TENS (transcutaneous electrical nerve stimulation).
• Progressive restoration of activity to avoid deconditioning.

Psychological Therapy

• Cognitive Behavioral Therapy (CBT) to manage chronic pain.
• Mindfulness, stress reduction and pain coping strategies.

Lifestyle Modifications

• Weight management.
• Smoking withdrawal (enhances recovery).
• Ergonomic modifications in routine.

Interventional Pain Therapy

(When patients are not responding to therapy/medications)

• Epidural steroid injection → suppress inflammation of nerve roots.
• Facet joint/medial branch blocks - when it is a facet joint problem.
• Radiofrequency ablation (RFA) = burns pain-carrying nerves in facet joints.
• Adhesiolysis (epidural lysis of adhesions) → scar tissue that compresses nerves is broken down.

Neuromodulation Techniques

(Also effective in chronic, refractory pain)

Spinal Cord Stimulation (SCS)

• Implants put under the skin.
• Intercepts the electrical signals transmitted to the brain to block the transmission of pain.
• Proven to be more successful than re-surgery in most FBSSs.

Intravenous paste injection (pain pump)

• The pain medication is sprayed to spinal fluid through implanted pump.

Surgical (Last Resort)

(Unless a fixable structural factor is found)

• Revision discectomy or decompression → recurring disc herniation or stenosis.
• Revision of the spinal fusion → in case of instability or pseudoarthrosis (unsuccessful fusion).
• Hardware change/replacement → screws, rods, cages have broken.

Multidisciplinary Pain Programs

• Integration of pain specialists, physiotherapists and psychologists.
• Prioritize on functional improvement and quality of life, and not pain removal.

Failed Back Syndrome treatment in India with GetWellGo

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• Complete transparency
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• 24 hour availability.
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• Assistance in selecting India's top hospitals for Failed Back Syndrome treatment.
• Expert spinal surgeon with a strong track record of success
• Assistance during and after the course of treatment.
• Language Support
• Travel and Accommodation Services
• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
• Currency Exchange
• Arranging Patient’s local food