Anyone suffering from back pain caused by a herniated disc or other spinal changes needs to think very carefully about whether surgery can achieve the relief they hope for. It is crucial not to operate too early, because a large percentage of surgeries do not produce the desired result. Failed back surgery syndrome is then the result.
What is failed back surgery syndrome?
Failed back surgery syndrome (also postdisectomy syndrome or postnucleotomy syndrome) is the term used to describe pain and also discomfort following surgery on the intervertebral disc or spine. The use of the English term here assumes the failed back surgery, but equally common are the Latin terms. Basically, failed back surgery syndrome is a complication that occurs in about 30 to 50 percent of patients. In this case, the pain may initially improve immediately after surgery, only to flare up again. Sometimes there can also be a significant increase in pain. This can also radiate to the legs or even the groin region, causing a restriction in the patient’s mobility. There are also patients who continue to suffer from back pain immediately after surgery and who do not experience any improvement with treatment and are immediately affected by failed back surgery syndrome.
Causes
The causes of failed back surgery syndrome can be many and varied. In general, the decision to have surgery may have been made too early by the patient without waiting for possible treatment success from other applications. Another cause of failed back surgery syndrome may be incomplete removal of the disc fragments that have leaked out. Overloading of the spine after surgery may also be causative. In this case, the pain occurs primarily above and below the operated vertebral segments. Undesirable scarring or inflammatory reactions in the surgical area also lead to failed back surgery syndrome, as does any instability that may occur in the entire spine.
Symptoms, complaints, and signs
If the exact causes of pain are not addressed during disc surgery, the condition known as failed back surgery syndrome or postdisectomy syndrome can occur. In this syndrome, back pain that was already present before the surgical procedure, with radiation to one leg, either persists or flares up again shortly after surgery. Furthermore, the pain may even intensify as a result of surgery and additionally radiate to the groin or legs. Pain can occur anywhere in the spine. Depending on the cause, these are felt as burning, electrifying, pulling, dull or locally pressing. Due to the involvement of the nervous system, tingling, nocturnal calf cramps or an unpleasant feeling of coldness also often occur. Unbearable pain often occurs, especially when bending over. Furthermore, the “failed back surgery syndrome” can also lead to late effects. These manifest themselves, among other things, in instability of the spinal column, increased formation of connective tissue near the spinal cord, adhesions of the spinal cord’s spider tissue or in a repeated herniation of the intervertebral disc. Complete freedom from pain can no longer be achieved even with intensive drug and physical therapies. Physical therapy aims to stabilize the spine in the long term. Drug therapies have a calming effect on the nervous system. However, nerve irritation is chronic, so only prolonged and complex treatment methods gradually lead to pain reduction and thus improve the quality of life.
Diagnosis and course
Failed back surgery syndrome can be diagnosed with imaging techniques. These include MRI (magnetic resonance imaging) and CT (computed tomography). However, the results of these examination methods regarding failed back surgery syndrome should be evaluated cautiously with regard to follow-up surgery, as other treatment options should be tried beforehand. The development of pain in failed back surgery syndrome often takes a chronic course. The main focus should then be on appropriate pain management.The support of a psychologist can also help manage the ongoing pain of failed back surgery syndrome.
Complications
In many surgeries, the so-called failed back surgery syndrome occurs, which can lead to significant discomfort and complications in the patient’s daily life. Usually, this involves extremely severe pain in the back. This pain is mainly stabbing and can also spread to other regions of the body and cause pain or unpleasant sensations there. It is not uncommon for failed back surgery syndrome to also cause numbness and sensory disturbances throughout the body. Muscle weakness also occurs and the affected person feels tired and fatigued. Furthermore, paralysis also occurs, which usually leads to movement restrictions and generally to severe limitations in the patient’s everyday life. Not infrequently, these complaints also lead to depression or further psychological upsets. There are no further complications during the treatment itself. This takes place mainly through various therapies and can alleviate the discomfort. However, a positive course of the disease is not possible in every case, so that not all pain can be completely limited. If the pain due to failed back surgery syndrome also occurs at night, it can lead to sleep disturbances.
When should you see a doctor?
Failed back surgery syndrome must be examined by a doctor in any case. With this condition, there is usually no self-healing and in most cases, unfortunately, the symptoms worsen. For this reason, early diagnosis and treatment of the disease can prevent further complications. The doctor should be consulted when there is severe pain in the back. This pain is often stabbing and spreads to the neighboring regions. There are also sensory disturbances or paralysis. Possible muscle weakness may also indicate the condition and should be examined by a physician. Diagnosis and treatment of failed back surgery syndrome can be done by an orthopedic surgeon or by a physical therapist. In many cases, this can significantly reduce the pain and limitation of movement. However, many sufferers also rely on psychological treatment. In acute emergencies or very severe pain, a hospital can also be visited. There, the pain can be relieved directly with the help of anesthetics. However, painkillers should not be taken over a long period of time, so as not to damage the stomach and not to get into ene dependence.
Treatment and therapy
Treatment of failed back surgery syndrome is mainly concerned with relieving the pain that is present and thereby minimizing the limitation of movement. Physiotherapy applications are at the forefront of treatment options. These mainly include physiotherapy and transcutaneous electrical nerve stimulation (TENS). Physiotherapy under the guidance of a therapist aims first to strengthen the muscles of the back. In addition, the patient affected by failed back surgery syndrome learns exercises to help him or her avoid incorrect postures and the resulting incorrect stresses on the back in everyday life. The electrostimulation (TENS) can be easily continued by the patient at home. The device generates a harmless current that stimulates muscles and nerves, thereby relieving pain. Heat and cold therapy is also used to relieve pain from failed back surgery syndrome. This procedure can also be done before physical therapy, as it optimally prepares the muscles for treatment. Patients can learn to cope better with the pain of failed back surgery syndrome via relaxation techniques such as autogenic training. Acupuncture treatments also help with pain management. However, it is also essential to administer sufficient pain medication and, if necessary, muscle-relaxing drugs. Temporary relief of the pain of failed back surgery syndrome can also be achieved by local injections of narcotics at specific pain points by the physician.
Outlook and prognosis
In failed back surgery syndrome, no general statement can usually be made about the further outlook and prognosis of the disease, as these usually depend on the exact symptoms. However, if failed back surgery syndrome is not treated, there is usually no improvement in the symptoms and significant limitations in the patient’s life and daily routine. The affected person is dependent on the help of other people and can usually no longer cope with everyday life on his own. As a rule, some of the symptoms of the syndrome can be alleviated with the help of physiotherapy. Many of the exercises can also be performed in the patient’s own home to accelerate and promote healing. However, the patient with failed back surgery syndrome is still dependent on taking pain medications and narcotics, as the pain is usually severe. Often, further surgery is also necessary to permanently relieve the discomfort and make the patient’s life easier. Likewise, treatments using electrical stimulation can relieve the discomfort, although a complete cure usually cannot be achieved.
Prevention
Prevention of failed back surgery syndrome is very important. All conventional treatment options for back pain should be exhausted first, as well as targeted medication to relieve the pain. Surgery should only be attempted if all of the above measures are unsuccessful and the pain is unbearable. Ultimately, it is important to remember that about half of all back surgeries result in failed back surgery syndrome.
Follow-up
The options for aftercare prove relatively difficult in most cases of failed back surgery syndrome. At the same time, a complete cure of this disease cannot always be achieved, and the further course depends very much on the exact symptoms and their severity. As a rule, the life expectancy of the affected person is not limited by the failed back surgery syndrome. The syndrome is usually treated by physiotherapy or by various massages from physiotherapy. Some of the exercises from physiotherapy and also from physiotherapy can also be performed in the patient’s own home in order to increase the mobility of the body again and to alleviate the discomfort. When taking painkillers, the affected person should always pay attention to the maximum dose and not take too many painkillers over a long period of time. If there is any uncertainty, a doctor should be consulted to prevent further complications and interactions. Stress should also be avoided in failed back surgery syndrome. The affected person can use various relaxation techniques to relieve the discomfort, and some self-help options are also available to limit the discomfort.
Here’s what you can do yourself
To improve well-being, the affected person should control his or her movement patterns and initiate changes. One-sided loads, overstraining and strong physical tension should be avoided. Regular exercise and an ergonomic sitting posture can reduce complaints. The patient’s own weight should always be within the normal range according to the BMI. Excess weight is to be avoided, as it leads to complications and severe health impairments. The diet should be rich in vitamins and balanced. Unhealthy foods, consumption of nicotine or alcohol harm the patient and should be refrained from. Adopting rigid postures is also not advisable. Balancing movements of the entire body are important. Care should be taken not to pinch nerves or blood vessels. Shoes with high heels should not be worn. They increase the general risk of accidents and lead to changes in natural movement patterns. In everyday life, care should be taken to maintain a healthy posture when lifting, carrying or holding objects. Heavy objects in particular should not be moved without assistance. Sudden twisting movements or jerky movements should be avoided, as they often trigger immediate discomfort. On the other hand, a sufficient supply of warmth to the back and a straight posture are helpful in stabilizing the natural structure of the body.
