FBSS & FNSS: Dealing with Pain After Spinal Surgery
Failed Back Surgery Syndrome (FBSS) and Failed Neck Surgery Syndrome (FNSS) are more common than you think. What happened and what is causing this pain months or even years later?
Your back or neck surgery was supposed to provide relief. Months to years later, you are experiencing little to no improvements or pain in other areas. This surgery was a last resort, but didn’t seem to work. What happened and is this normal?
Failed Back or Neck Surgery Syndrome refers to any continued or new pain following a spinal procedure and is more common than you’d think. According to The National Center for Biotechnology Information this condition affects 20% to 40% of patients. Possible causes and complications vary depending on your symptoms and surgery. For a detailed account of your personal pain, it is recommended to schedule an immediate consultation with a revision surgery specialist to determine the best course of action.
Answers to these commonly asked questions about pain after spine surgery will help you determine if you are suffering from FBSS or FNSS, possible causes and care.
Do I have Failed Back Surgery Syndrome (FBSS) or Failed Neck Surgery Syndrome (FNSS)?
We all have good and bad days. Especially after a major and complex spine surgery, it’s expected to need physical therapy and pain management over time. However, recovery should be manageable. If months to years following surgery, you experience continued or a sudden onset of intense pain, numbness, or inability to complete daily tasks, you may be experiencing Failed Back or Neck Surgery Syndrome. If the following symptoms sound familiar, you should contact an orthopedic surgeon revision specialist.
- Continued lack of mobility
- Flair ups every time you bend over, sit or stand for too long
- Difficulty getting out of bed
- Avoiding staircases and high shelves
- Continued pain medication regimen similar to what you were on pre-surgery
- Joint pressure or shooting pain down your arms and legs
- Little to no increased quality of life or improvements
Understanding your Spinal Surgery Failure
Why am I having this pain after surgery?
Post-surgery pain is not only frustrating and disappointing, but can feel extremely scary. It’s difficult not to want to blame someone or something for your pain. Often patients wonder if it was their fault. The answer is: no, not usually. Although some factors including lack of physical therapy can greatly affect the body’s ability to heal from a spinal surgery, there are a number of factors out of your control.
The spine is complex. It is a highway of diverse structures and the source of communication between your brain and body. As you were hopefully told before surgery, cervical and lumbar surgery poses a number of risks and complications. To effectively treat your post-surgery spinal pain, a specialist will need to assess the pain source, potential misdiagnosis pre-surgery, and possible surgical complications. Pain at the initial surgical site, pain occurring at the surrounding vertebrae, or numbness in your extremities may all indicate various causes and complications that will determine the best route to proceed in treating your pain. View the below table for some possible surgical complications resulting from FBSS orFNSS.
Possible Causes of Failed Back and Neck Surgery Syndrome:
- Recurring Disc Herniation
- Surrounding Vertebrae Strain
- Lack of Fusion
- Hardware Complication
- Nerve Damage
- Scar Tissue Inflammation
Surgery for a herniated disc only removes part of the disc, leaving a portion that could continue to bulge and eventually herniate as well. Wear and tear on the spine creates a natural breakdown of cushion between the vertebrae and gets worse with age. According to an article in Science Daily, after age 40, disc degeneration doubles every 20 years. Though not all degeneration results in a herniation, your risk of Recurrent Disc Herniation may increase with age.
Surgery increases tension and reliance on surrounding joints, often resulting in strain and possible injury of vertebrae above or below the initial surgical site over time. This is often referred to as: “Adjacent Segment Degeneration Disease.” Proper physical therapy, exercise, and care are prescribed post surgery as a preventative for surrounding vertebrae complications. However, injury, age, and stress from the surgery can cause complications to other parts of your spine.
Your cervical or lumbar fusion may not have properly fused. Spinal fusion surgery simply provides the condition for the bones to fuse, but is extremely complex in surgery and post surgery. A year after surgery, over half of fusions fail to occur, referred to as “Pseudarthrosis.” Causes may range from hardware, lack there of, bone graft, misdiagnosis, surgical procedure type, or personal health and habits. A Very Well Health article quotes a spinal textbook that states fusions without hardware implants are at a 70% higher risk of Pseudarthrosis.
More common in complex and longer surgery procedures, pain at the surgical site may indicate “Painful Hardware Syndrome.” Causes could include: loose screws, hardware detachment, surgeon error, or implant infections. Age and diabetes seem to play a role in the loosening of screws in a study discussed in The Journal of Neurosurgery.
Numbness, pain, or lack of proper mobility anywhere in the body could indicate nerve damage, or “Arachnoiditis.” Nerves are surrounded by a protective cushion that may have gotten damaged during the procedure. Mild to severe symptoms can result from Arachnoiditis from occasional pain to a lack of proper function of the bladder or extremities.
An overabundance of scar tissue formation, known as Epidural Fibrosis, doesn’t always result in painful symptoms. Scar tissue is part of the body’s natural healing process, and will present in most spinal surgeries. However even with initial spinal surgery success, a sudden increase in pain months following a procedure could be caused by this excess scar tissue build up and inflammation.
If I have Failed Back Surgery Syndrome (FBSS) or Failed Neck Surgery Syndrome (FNSS), what’s next?
Most likely, treatments for FBSS and FNSS will look very similar to what you encountered pre-surgery. Unless there is an immediate cause to reenter the surgical site, doctors will usually begin with pain management and rehab including: steroid injections, spinal cord stimulation, drug infusions, narcotics, and physical therapy.
If pain management and therapy do not improve your quality of life, your doctor may discuss a revision surgery. The word surgery can be daunting, especially after the complications and pain you’ve already encountered from a spine surgery. However, a proper revision surgery specialist can discuss additional tactics that can encourage a proper recovery this second time around.
Revisiting an already irritated surgical site requires additional expertise and understanding. Dr. Prpa is a highly regarded neurosurgeon and revision specialist.
Make an appointment today for a consultation on your FBSS, FNSS, and post op pain. Don’t wait until your symptoms get worse; Dr. PRPA will perform a full assessment to determine your best options for relief and get you on the road to recovery.