Failed Back Syndrome

Failed back syndrome is a general term that refers to chronic severe pain experienced after unsuccessful surgery for back pain. Surgery for back pain is conducted when there is an identifiable source of pain-usually to decompress a pinched nerve root or to stabilize a painful joint. However, back pain can have a number of causes and accurate identification of a source of pain is complicated; often symptoms do not correlate well with x-rays or magnetic resonance imaging (MRI) scans. The pain may result from scarring on nerves originating from the spinal cord. This would be categorized as a radiculopathy, meaning that the pain radiates from an overactive nerve root. A failed back may result from a joint that has become irritated and inflamed because surgery altered the person’s posture, gait, and way of moving. Another possibility is that the surgery has disrupted the usual way muscles are positioned or function and has triggered myofascial pain related to sore areas within muscles. Scar tissue always forms following surgery and may be a source of pain. Any surgery is going to change the back’s configuration, which always raises the possibility of new problems. This is why no surgeon can give an ironclad guarantee of long-term success. Medicine’s recent understanding that spinal discs and structural weaknesses are not always the cause of low back pain has changed significantly the way that doctors view back pain and back surgery. This is one of the lessons of failed back syndrome and another compelling reason for initially approaching back pain by looking to less invasive therapies. For example, treatments that change the way the back is used, rather than changing the back itself, should be looked at first.

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