Patients often turn to spine surgery after enduring years of pain and conservative treatment. They might expect this procedure will finally resolve their back or neck problems and allow them to move on with their lives. However, this isn’t always the case.
Pain and other symptoms can return after spine surgery, a condition commonly known as failed back surgery syndrome (FBSS). This can leave the patient feeling frustrated, disappointed, and angry.
Despite the name, failed back surgery syndrome doesn’t mean the surgery itself failed or the surgeon deviated from the standards of care.
WHAT IS FAILED BACK SURGERY SYNDROME?
Failed back surgery syndrome refers to a subset of patients who experience new or persistent pain after having spinal surgery for back or leg pain. There can be many reasons for this, including the buildup of scar tissue, muscle spasms, or failure of fusion to form solidly (pseudoarthrosis).
The condition is surprisingly common, affecting 20-40% of patients. The risk of experiencing FBSS rises with each spine surgery. A 2018 review found only about 50% of initial surgeries are successful. That drops to 30% after the second surgery, 15% after the third surgery, and 5% after the fourth surgery.
Risk factors indicating which patients are at the highest risk for the condition include: smoking; obesity; anxiety, depression or other psychiatric conditions; worker’s compensation injuries; other chronic pain issues, such as fibromyalgia.
Research shows psychosocial factors have the strongest association with developing FBSS.
Pain management physicians have suggested the condition should be renamed. They feel the name FBSS implies there was a problem or error during the surgical procedure, which isn’t necessarily true. They suggest “Persistent Spinal Pain Syndrome” as a more accurate name.
NOT ALL PAIN INDICATES FAILED BACK SURGERY
To further complicate matters, not all instances of pain after back surgery constitute FBSS.
There are several reasons why some continued or recurring pain might be a normal expectation after spinal surgery.
In some cases, patients may have had multiple pain generators before surgery. For example, the patient might have pain caused by both back and hip issues. Surgery to the spine may correct the back pain. However, the patient would still be experiencing hip pain. The hip pain may even be more noticeable to the patient now that the back pain is absent.
Another possible cause is known as adjacent segment disease. This is where the patient experiences continued spine degeneration next to the previous surgery’s levels. This can be caused by the progression of an underlying disease process or by changes to the way the spine moves after surgery.
None of these situations inherently indicates the surgeon has done something incorrectly or the initial surgery wasn’t successful in achieving its goal.
EDUCATION AND EXPECTATIONS
Unfortunately, the fact a procedure may have gone exactly according to the surgeon’s plan doesn’t prevent some patients from being disappointed or angry when the outcome of their surgery isn’t what they had hoped for.
Unhappy patients may leave negative reviews, seek out a new surgeon, or even consult a malpractice attorney.
The best way for surgeons to protect themselves is to ensure: the patient is adequately educated about the goals of the procedure; the patient has realistic expectations of the results; and both of these are documented in the medical records.
Best practices say patients should receive proper education from a multidisciplinary team consisting of physicians, nurses, and physical therapists on the goals and risks of surgery both before and after the procedure.
One study found patients who had realistic expectations and proper pre-procedure education had higher opinions of their surgeons even when they developed chronic post-surgical pain.
WHAT DOES THIS MEAN FOR ATTORNEYS?
Pain that continues or reoccurs after spine surgery is a common occurrence. Depending on the patient’s medical history and the procedure performed, this could indicate a deviation from the standard of care during surgery or a completely expected outcome.
Careful assessment of the patient’s medical records is necessary to differentiate these two possibilities.
While distressing to the patient, the mere presence of pain after back surgery is not enough evidence to conclude the spine surgery failed or didn’t meet the standards of care.
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5913031/
https://www.neuromodulation.com/failed-back-surgery-syndrome-definition
https://nyulangone.org/conditions/failed-back-surgery-syndrome/diagnosis
https://www.ncbi.nlm.nih.gov/books/NBK539777/
Comments 1
I was scared into hiring the place to do emergency spine surgery, the surgeons first words from his mouth first meeting was “how did you get in here?
You should be paralyzed or paraplegic right now”
I had been in hospital once when 18, then 3 years ago was 56.
At that meeting, I was disabled from life of child torture, leading to severe panic, anxiety, PTSD.
I only noticed suddenly 1 evening the tips of my fingers and toes were little numb.
I was flat out lied to, I asked several times what worst could be, was told “in a year, you will be back to your normal routine EXCEPT LIMITED RANGE IF MOTION in neck, and possibly the slight numbness in fingers and toes possibly might remain,but most likely not.”
That was extent of what staff and surgeon told me.
After 6 min it was clear somethings ng was wrong, and I was terrified, pain and numbness was increasing, other new symptoms, the surgoen said I was fine, Md that was last time allowed to see him, I had been personally attacked verbally by staff, even accused of outright faking my symptoms, it rggaherating them, they turned on my literally overnight, from so nice to cruel and mean. I was banned from sei g the surgeon. I was told total conflicting info on each visit and had recorded in my phone which is legal in ks, they wentbeserk, screaming at me, them the male nurse who interrogated me and accused me of faking and went berserk when told I had him on recording tried to get my phone from me and when that failed, left me and slammed the door so hard I joked, and heard him screaming down hall “HE RECORDED US, HE RECORDED US!!!”
by then KU had taken over and things got worse,I was accused of harassing and scaring nurses at time of surgery, so untrue, plus I was in brace, immobile doped up and in pain.
I had been blacklisted by KU, only found out when a 2nd trip to same hospital where surgery was done I was purposely denied seeing anyone, and lied toby staff, and called them out on it. We left both times after waiting and no one ever came to help. Was in excruciating pain and severe panic my panic attacks last min of 1 hour, and have been deemed uncontrolled after 26+ years of trying every med and leading to stroke from severe reaction. To pristiq which led to my fighting 4 years for DSDI. Kd SSA committed fraud, the Dr they sent me to was so crooked it was insane, when at my court appearance before law judge, she threatened the SSA rep with contemp of court over the fraud. I was given fully favorable decision by the judge at time of my hearing.
My lawyer said in his 30 years I was only 2nd person to ever get a decision at actual hearing.
I was called by a woman after the ER visit with no help, she ended up talking g for 2 hours and told me I was blacklisted, what it was and why, then told me she was hospital employee over 20 years, her mother had same exact surgery by same surgeon as me, and they did exact same to her as me and was now in assisted living g in wheelchair paralyzed.
She said she had been demoted to the job she had now for complaining. I was not given her name, she said never come to thishidpital again, even if heart attack.
Office lady from surgeons office I saw the year I was under their care and got to know, she was PTSD and same meds as me, she was kind, and the day I was assaulted in office by male nurse I broke down crying at her desk in waiting room, the pain and being accused was too much, she helped me outside, and talked tome while I took Valium to try to calm,she had been arguing when I got there with new KU staff and outside she told me they had been instructed by new KU staff ,”TO NOT SHOW EMPATHY OR COMPASSION TO PATIENTS ONLY TO COMMUNICATE WHAT EAD TEQUIRED FIR INTAKE AND APPOINTMENTS”, SHE SAID SHE COULD NOT WORK THERE AMYMORE, AND quit shortly after, I talk to her on FB.
Been 2 years since surgery, I pray to die ever day. I have seen outside neurosurgeons, seeing another Tuesday, all have agreed the surgery was excessive and has caused the permanent pain and worsening g of symptoms, but have since been less nice I know KU surgeon and staff have lied to them and they believe them can’t find any Dr who will do anything g but band audvortixone shots, which are risky and proven temp at best.
I am typing with dead hand with no feeling,severe pain and crying. My wife has aged since my surgery and wTchi g Mr suffer day by day.
I called a large area law firm and was literally hung up on. A friend who’s retired attorney told me KU, where they got their law licence, has got so big and powerful, and politically connected, that no law firm will take my case. So I suffer and beg God every night for death as I get worse, I can’t walk well, can’t feel feet or hands can’t shave shower brush teeth, drive, even fegicate without incredible pain
PLEASE HELP ME PLEASE!!!