Failed back surgery syndrome (FBSS) is a broad term that is used to describe chronic pain after spinal surgery. Generally, it is used when a specific cause of the failure cannot be identified. It is considered by some to be a misnomer, a term for a group of symptoms (and so not a definable syndrome). Whatever their opinion on the legitimacy of FBSS as a syndrome may be, every spine surgeon wants to avoid a “failed” procedure.
There are some concrete, clearly identifiable reasons that spine surgery can fail. These include pseudoarthrosis, transitional syndrome, disc reherniation, postoperative spinal instability, postoperative infection, and failed hardware. Because the direct causes of these failures can be identified, they can be treated and, in many cases, resolved. FBSS is quite different.
There are many theories about the origin of the chronic pain associated with FBSS. Is it a failure to accurately assess and target pre-operative symptoms? Is it a result of the trauma of surgery itself? Does it result through some quirk in the healing process after surgery? The questions are many and, in most cases, the answers are few. But simply because we cannot answer these questions, it does not make the FBSS patient’s pain any less real.
Prevention is on the top of every surgeon’s mind. We want the best outcomes for our patients. We want our surgeries to be successful. So how can we prevent this from happening? The only surefire way to prevent FBSS is to avoid surgery.
Now, avoiding surgery whenever possible is just a good general rule, one that I definitely implement. However, when I see people with severe scoliosis, malignant tumors, and spinal cord injuries at my Long Island practice, surgery may be imperative. With each patient, all surgeons can do is use our knowledge and experience to gauge when surgery is necessary, and then perform the procedure to the very best of our ability.