Failed Back Surgery

Failed back surgery syndrome (also called FBSS, or failed back syndrome) is a misnomer, as it is not actually a syndrome – it is a very generalized term that is often used to describe the condition of patients who have not had a successful result with back surgery or spine surgery and have experienced continued pain after surgery. There is no equivalent term for failed back surgery syndrome in any other type of surgery (e.g. there is no failed cardiac surgery syndrome, failed knee surgery syndrome, etc.).

Failed back surgery syndrome (FBSS) is seen in 10-40 percent of patients who undergo back surgery. It is characterized by intractable pain and varying degrees of functional incapacitation occurring after spine surgery. There are many reasons that a back surgery may or may not work, and even with the best surgeon and for the best indications, spine surgery is no more than 95% predictive of a successful result.

Reasons for Failed Back Surgery and Pain after Surgery

Spine surgery is basically able to accomplish only two things:

Surgically decompress a nerve root that is pinched, or
Stabilize a painful joint

Unfortunately, back surgery or spine surgery cannot literally cut out a patient’s pain. It is only able to change anatomy, and an anatomical lesion (injury) that is a probable cause of back pain must be identified prior to rather than after back surgery or spine surgery.

By far, the number one reason some patients experience continued pain after surgery, is because the lesion that was operated on is not in fact the cause of the patient’s pain.

Predictability of Pain after Surgery

Some types of back surgery are far more predictable in terms of alleviating a patient’s symptoms than others. For instance,

A discectomy (or microdiscectomy) for a lumbar disc herniation that is causing eg pain is a very predictable operation. However, a discectomy for a lumbar disc herniation that is causing lower back pain is far less likely to be successful.
A spine fusion for spinal instability (e.g. spondylolisthesis) is a relatively predictable operation. However, a fusion surgery for multi-level lumbar degenerative disc disease is far less likely to be successful in reducing a patient’s pain after surgery.

Therefore, the best way to avoid a spine surgery that leads to an unsuccessful result is to stick to operations that have a high degree of success. And, to make sure that an anatomic lesion that is amenable to surgical correction is identified preoperatively.

Other Causes of FBSS and Continued Pain after Surgery

In addition to the above-mentioned cause of failed back surgery syndrome, there are several other potential causes of a failed surgery, or continued pain after surgery:

Fusion surgery considerations (such as failure to fuse and/or implant failure, or a transfer lesion to another level after a spine fusion, when the next level degenerates and becomes a pain generator).
Lumbar decompression back surgery considerations (such as recurrent spinal stenosis or disc herniation, inadequate surgical decompression of a nerve root, preoperative nerve damage that does not heal after a decompressive surgery, or nerve damage that occurs during the surgery).
Scar tissue considerations (such as epidural fibrosis, which refers to a formation of scar tissue around the nerve root). Post-operative rehabilitation (continued pain from a secondary pain generator).

Scar Tissue and Continued Pain After Back Surgery

Scar tissue formation is part of the normal healing process after back surgery. While scar tissue can be a cause of pain, actual scar tissue pain is very rare since the tissue contains no nerve endings. Rather, the principal mechanism of pain is thought to be the binding of the lumbar nerve root by fibrous adhesions, called epidural fibrosis. Postoperative stretching exercises can help decrease the effects of postoperative scarring around the nerve root.

Scar Tissue Formation after Back Surgery

All patients will heal with scar tissue after undergoing back surgery, as this is the only way to heal. The reality is that although scar tissue is often clinically the reason given for continued pain after surgery, it is probably rarely the cause of postoperative pain. Particularly in patients that have similar pain postoperatively to what they had before surgery, it is unlikely that the addition of scar tissue has an clinical relevance.

However, clinicians often use the explanation of scar tissue as the cause of continued pain, whether or not there is any evidence that this is in fact the patient’s pain generator. Often, a better explanation for continued pain after surgery is that either the patient has a secondary problem that needs to be addressed, or that the lesion operated on was not in fact the source of the patient’s pain. These are far more likely scenarios than actual scar tissue pain.

A Possible Exception for Scar Tissue Pain

The one time that scar tissue (epidural fibrosis) may be symptomatic is for a patient who initially does well after a lumbar discectomy or a surgical decompression, only to have recurrent pain come on slowly between 6 to 12 weeks after surgery. This is the time period that scar tissue takes to form, and as it forms it can cause the nerve root to become adherent within the spinal canal. Keeping the nerve moving through stretching exercises can help prevent this scenario. Pain that starts years after surgery, or pain that continues after surgery and is never relieved, is not from scar tissue.

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“I searched everywhere for an answer to my back pain and the nagging sciatica in my right leg. Painkillers helped for a while but I knew that wasn’t the long-term solution. After an MRI scan confirmed my L5 disc was bulging in my low back ..."

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“I suffered a whiplash injury in 2008 and one of the discs in my lower neck was injured. I tried many different types of treatment and was desperate to avoid surgery. A friend told me about this new Spinal Decompression Therapy..."

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“I went to Dr. Doug when I found out that I had spondylosis and two worn out discs at the base of my spine. My back was so stiff and sore, especially in the mornings and I knew I had to do something about it before it got any worse ..."

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What is Non-Surgical Spinal Decompression?
Will Spinal Decompression Therapy treatments hurt? Is it safe?
Is Spinal Decompression Therapy new?
Will I require an x-ray, MRI or CT scan?
Why is Spinal Decompression Therapy more successful than other treatment options?
Why the need for exercises and other therapies?
How much will it cost?
Can Spinal Decompression Therapy help my pain?
Will my pain go away for good?
How long will my treatment program be?

What is Non-Surgical Spinal Decompression?

Non-surgical spinal disc decompression is a non-invasive treatment for acute and chronic spinal pain associated with herniated, ruptured, bulging or degenerative discs and sciatic leg pain or spinal stenosis associated with these conditions. It is also used for the treatment of conditions such as facet syndrome, spondylosis and even failed spinal surgery. It is safe and effective without the normal risks associated with invasive procedures such as injections, anesthesia or surgery. Spinal decompression works through a series of alternating decompression and relaxation cycles with a total treatment time of 12-25 minutes.

The theory behind non-surgical spinal decompression is that significant distractive forces, when applied to the lumbar spine in variable directions can create a negative pressure in the center of the intervertebral disc, thereby creating a suctioning effect or “vacuum phenomenon” in order to retract or reduce the size of the herniated or bulging disc's gelatinous internal nucleus pulposus, thus diminishing or eliminating nerve compression, while at the same time creating an osmotic gradient which helps bring nutrients and water into the disc. Since intervertebral discs have poor circulation, they depend upon receiving their nutrition through diffusion across the endplates of the vertebrae above and below.

The appeal of non-surgical spinal decompression is that it is a non-invasive, non-surgical, drug-free alternative treatment for low back pain, sciatica, disc degeneration, disc bulges, disc herniations, and facet syndrome. There is copious anecdotal evidence of its effectiveness and more case studies are being published demonstrating very positive results in patients who have tried other conservative treatments that have failed.

Will Spinal Decompression Therapy treatments hurt? Is it safe?

Spinal Decompression Therapy treatments are one of the most gentle and comfortable therapies available. The treatments utilize equipment with proven safety and efficacy. Most patients report a mild sense of stretch on their back or hips, and often fall asleep during treatment sessions.

Is Spinal Decompression Therapy new?

Although traction therapy has been around for thousands of years, spinal decompression is relatively new. Advances in equipment and procedures have dramatically improved effectiveness. Cork Spine & Disc Rehabilitation Centre is the only clinic in Co. Cork that uses the Kennedy Neural-Flex Decompression table. We believe this to be the most sophisticated, technologically advanced, state-of-the-art decompression system in the world. Dr. Doug Meckelborg is currently the only “Kennedy Certified Practitioner” in Co. Cork.

Will I require an x-ray, MRI or CT scan?

After your initial consultation at our clinic and a comprehensive physical examination, it will be determined whether diagnostic imaging is required. Often, MRI (Magnetic Resonance Imaging) scans, or in some cases, CT (Computerized Tomography) scans help to confirm the diagnosis and elucidate the nature and extent of the underlying problem. If required, we would refer you to one of the clinics in Cork that provide such services.

Why is Spinal Decompression Therapy more successful than other treatment options?

Spinal Decompression Therapy is a comprehensive program of the newest traction techniques and targeted “core” stabilization exercises. Doctor skill, combined with the decompression table and computerized traction head, are the keys. Proper assessment, correct positioning and the use of pre-programmed patterns of distraction and relaxation reduces intervertebral disc pressure, thus allowing necessary nutrients to “enliven” and accelerate disc healing. In addition, we use other adjunctive treatments that have proven effectiveness in spinal care. It is this multi-faceted approach that makes the overall treatment so effective. Additionally, the disc has been shown to be a predominate site of pain in many spinal conditions, so treating it as directly as possible makes sense. The blending of focused decompression to the site, rehabilitation to the supporting structures, and overall strengthening of global musculature makes the treatment unique.

Why the need for exercises and other therapies?

Along with the damage in the disc we also need to treat the supporting spinal muscles. A complete program targeting the function of the stabilization muscles is a vital part of Spinal Decompression Therapy. Our hope is not only to help heal the disc but enhance muscle control and support of the low back or neck. A gradual breakdown of the foundational support of your back or neck is what puts undue stresses on the discs and leads to pain and loss of function. Exercise and adjunctive therapies will assist in rehabilitating these structures.

How much will it cost?

We offer affordable and individually tailored programs of spinal care depending on the nature of your condition and the extent of care needed. Most major insurance companies in Ireland (VHI, Quinn Direct, Hibernian Aviva) will cover a portion of your care. You always have the choice as to the extent of care you receive. Our staff will review all costs, payment options and insurance coverage up front. We want to help, and believe finances shouldn’t stand in the way of you and good health.

Can Spinal Decompression Therapy help my pain?

Though each patient is different and no doctor can guarantee 100% success, our office is seeing great results from spinal decompression therapy. Damaged discs, joint dysfunction and poor spinal muscle control are among the most common problems underlying mechanical back pain. Our treatment program addresses both of these core problems. The Spinal Decompression Therapy creates a controlled decompression of the vertebral discs to decrease disc pressure thus increasing blood and nutrient exchange. This exchange of fluids is something the damaged disc desperately needs to help it heal from the inside out. Muscle strength, control and endurance can all be improved with other facets of Spinal Decompression Therapy that include specific controlled exercises.

Will my pain go away for good?

Although it is difficult to predict the future, our experience is that most patients do find long-term relief or effective management of their pain when they complete the entire program of treatments. Regular home exercise and periodic visits to our clinic will help in maintaining your spinal health and reduce the probability of reoccurrence. As with any comprehensive rehabilitation program your continued home care exercises and discretion in some daily activities is key to long-term relief.

How long will my treatment program be?

It depends on the nature of your injury as well as the complexity and extent of the rehabilitation needed; however, we typically begin with 3-4 treatments per week for 1 month followed by re-examination to assess progress. The treatment is administered over a reasonable time frame and your response is continually evaluated. Further treatments may be necessary or a reduced frequency may be recommended at that time. The rehabilitative phase may include additional Spinal Decompression treatments, with other adjunctive spinal therapies to enhance the results.