Failed Back Surgery

Can You Tell if You Have Immediate Back Surgery Failure?

Not all back surgery is successful at resolving back pain and other symptoms such as leg pain, numbness, weakness and incontinence. How long, though, does it take to tell if a spine procedure has worked? Can your surgeon detect immediate back surgery failure?

According to a paper published 2014 in the journal Neurosurgery Review, there is little research regarding immediate failed back surgery syndrome (iFBSS) after lumbar microdiscectomy. iFBSS, as defined by these authors, comprises persistent, deteriorating, or recurring symptoms and signs, during a patients stay in hospital after surgery, of radicular pain, sensorimotor deficits, or sphincter dysfunction, or a combination of these. The diagnosis of iFBSS is only made if, according to the surgeon, the surgery itself was uneventful.

In this review, Rohde and colleagues looked at the medical records for 1546 patients who underwent discectomy for disc herniation in the lower back. They screened the patients for iFBSS and found 44 patients (2.8%) who fit their criteria for a diagnosis of immediate Failed Back Surgery Syndrome (iFBSS). These 44 patients all had a second back surgery procedure to try to address the residual problems.

The most common cause of iFBSS was residual disc material or re-herniation, which accounted for 22 of the 44 cases of iFBSS. There were also 6 epidural hematomas (an accumulation of blood in the epidural space), 2 cases of insufficient decompression of spinal stenosis, and one dural tearwith fascicle herniation. In 13 cases, there was no clear cause of iFBSS, but the researchers diagnosed battered root syndrome, a condition involving swelling of the nerve root after excessive manipulation during surgery.

Battered Nerve Root Syndrome After Back Surgery

A diagnosis for iFBSS was made in 25 of 43 patients who underwent neuroradiological imaging. A radiological work-up was not overly helpful in figuring out the cause of the failure of back surgery. The authors noted that it is necessary to figure out the cause of iFBSS in order to avoid carrying out unnecessary surgery on those with battered nerve root syndrome. In fact, they propose further surgery only for patients with new radiculopathy, or radiculopathy that persists even with treatment to relieve edema.

Most people who undergo spine surgery feel some degree of pain relief, or relief of other symptoms, in the first week or so after their procedure. A lucky few have an immediate response to spinal decompression and can feel a difference as soon as they wake up from general anaesthesia. For others, especially those who incurred more severe nerve damage prior to surgery, may never have symptoms resolve fully, or may take months or even years to be free from symptoms.

It is fairly common to experience some degree of discomfort and pain after any type of surgery, but patients who have severe or worsening pain and/or unusual symptoms after back surgery should alert their surgical team as this could indicate a complication of surgery. Addressing an epidural hematoma early can prevent permanent nerve damage, and treating an infection promptly is also advisable so as to minimise its spread and the risk of lasting tissue damage after back surgery.

Rohde V1, Mielke D, Ryang Y, Gilsbach JM. The immediately failed lumbar disc surgery: incidence, aetiologies, imaging and management. Neurosurg Rev. 2014 Sep 23. [Epub ahead of print]

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